手足口病患儿细胞免疫功能与相关 细胞因子水平变化的临床研究

Clinical study on changes of cellular immune function and cytokine levels in children with HFMD

摘要:

目的 分析手足口病（HFMD）患儿循环血T 淋巴细胞亚群、NK 细胞及细胞因子水平变化及意义。 方法 回顾性分析2016 年1 月—2018 年6 月在川北医学院附属医院就诊的68 例HFMD 患儿，分析其治疗 前后细胞免疫功能与相关细胞因子水平变化，探讨其与病情程度的关系。结果 68 例HFMD 患儿作为观察 组，该院健康体检儿童25 例作为对照组。观察组以单一病毒感染最为常见，肠道病毒71（EV-71）构成比最 高（47.06%），其次为EV-71+CA16 的（14.71%）。观察组治疗前CD4+T、CD8+T、NK 细胞水平低于对照组 （P <0.05）；观察组白细胞介素-10（IL-10）、白细胞介素-17（IL-17）及肿瘤坏死因子-α（TNF-α）水 平高于对照组（P <0.05）。重型HFMD 组治疗前CD4+T、CD8+T 水平低于普通型HFMD 组（P <0.05），而 NK 细胞水平高于普通型HFMD 组（P <0.05）；重型HFMD 组IL-10、IL-17 及TNF-α 高于普通型HFMD 组（P <0.05）。观察组患儿治疗7 d 后CD4+T、CD8+T 及NK 细胞水平较治疗前高（P <0.05），而治疗后IL- 10、IL-17 及TNF-α 水平较治疗前低（P <0.05）。结论 HFMD 发生机制与机体细胞免疫功能异常和相关 细胞因子水平失衡相关，并对疾病的发生、发展、病情评估及转归有重要指导作用。

Abstract:

Objective To analyze changes and significance of T lymphocyte subsets, NK cells and cytokine levels in circulating blood of children with hand foot and mouth disease (HFMD). Methods Retrospective analysis was used to analyze the changes and significance of cellular immune function and related cytokine levels before and after treatment in 68 children with hand-foot-mouth disease admitted to the hospital from January 2016 to June 2018, and to explore the relationship between the changes and the severity of the disease. Results Among the 68 children with HFMD as observation group and 25 healthy children as control group, single virus infection was the most common. The Enterovirus 71 (EV71) infection appeared the highest (47.06%), followed by EV71+CA16 mixed infection (14.71%). The levels of CD4+T, CD8+T and NK cells in the observation group were lower than those in the control group (P < 0.05). The leukin-10 (IL-10), interleukin-17 (IL-17) and Tumor necrosis factor (TNF-α) levels in the observation group were significantly higher than those in the control group (P < 0.05). Before treatment, CD4+T and CD8+T levels in the severe HFMD group were lower than those in the normal HFMD group (P < 0 .05), and NK cell levels were higher than those in the normal HFMD group (P < 0.05). IL-10, IL-17 and TNF-α were all higher in the heavy HFMD group than in the normal HFMD group (P < 0.05). The levels of CD4+T, CD8+T, and NK cells in the observation group were all higher after 7 days of treatment than before (P < 0.05), and the levels of IL-10, IL-17, and TNF-α were lower after treatment than before (P < 0.05). Conclusions The pathogenesis of children with HFMD is related to the abnormality of cellular immune function and the imbalance of cytokines, which plays a guiding role in the occurrence, development, evaluation and outcome of the disease.