糖皮质激素对支原体肺炎患儿免疫功能的影响

摘要

目的 评估糖皮质激素治疗对支原体肺炎(MPP)患儿免疫球蛋白和T淋巴细胞亚群细胞因子的影响.方法 选取MPP住院患儿420例,按随机数字表法分为激素治疗组和非激素治疗组,各210例.选择同期体检健康儿童30例为正常对照组.常规治疗基础上,激素治疗组另加用甲泼尼龙1 ～2 mg/(kg·d)静脉滴注联合布地奈德雾化吸入治疗,共3～5d.观察3组淋巴细胞亚群因子、免疫球蛋白等指标的变化.结果 治疗前,激素治疗组CD3+、CD4、CD8+、CD4+/CD8+分别为(32±l1)％、(29±11)％、(31±17)％、(1.0±0.3)％,IgA、IgG和IgM分别为(1.7±0.5)、(13.4±1.7)、(1.8±0.4) g/L;非激素治疗组分别为(32±11)％、(29±l1)％、(32±18)％、(0.9±0.6)％,(1.8±0.3)、(12.4±1.5)、(1.9±0.2)g/L；正常对照组分别为(62±21)％、(40±5)％、(22±32)％、(1.7±0.6)％,(1.2±0.8)、(9.3±2.6)、(1.3±0.6)g/L.激素治疗组与非激素治疗组比较,上述各指标差异均无统计学意义(均P＞0.05)；2组分别与正常对照组比较,差异均有统计学意义(均P ＜0.05).治疗后,激素治疗组CD3+、CD4+/CD8+高于非激素治疗组,CD8+低于非激素治疗组,组间差异均有统计学意义[CD3+:(47±9)％比(39±9)％,CD44+/CD8+:(1.8±0.5)比(1.2±0.5),CD8+:(18±7)％比(28±8)％,P＜0.01].激素治疗组IgA、IgG和IgM与非激素治疗组比较,差异无统计学意义(P＞0.05).结论 MPP患儿存在细胞免疫功能受抑制,体液免疫功能紊乱,小剂量糖皮质激素可以有效地调节MPP患儿的免疫功能.%Objective To evaluate the changes of immunoglobulin and T lymphocyte subsets in mycoplasma pneumonia (MPP) with glucocorticoid.Methods All 420 children with MPP were enrolled and randomly divided into two groups:glucocorticoid group and non-glucocorticoid group,with 210 cases in each group.Moreover,the glucocorticoid group was treated with methylprednisolone via intravenous drip [1-2 mg/(kg · d)] and budesonide via atomizing inhalation for 3-5 days.The non-ghcocorticoid group was remained untreated.In addition,30 healthy children were included as normal control group.The changes of immunoglobulin and T lymphocyte subsets were observed.Results Before treatment,the percentages of CD3+,CD4+,CD8+ T cells,the ratio of CD4+/CDs+ T cells and the IgA,IgG and IgM levels in glucocorticoid group were (32 ± 11)％,(29 ± 11)％,(31 ± 17)％,(1.0 ±0.3)％,(1.7 ±0.5) g/L,(13.4 ± 1.7) g/L,(1.8 ±0.4)g/L respectively.While the data was (32 ±11)％,(29 ±11)％,(32 ±18)％,(0.9 ±0.6)％,(1.8 ±0.3)g/L,(12.4 ±l.5)g/L,(1.9 ±0.2)g/L in nonglucocorticoid group,and (62 ±21)％,(40 ±5)％,(22 ±32)％,(1.7 ±0.6)％,(1.2 ±0.8) g/L,(9.3 ±2.6) g/L,(1.3 ± 0.6) g/L in normal control group.All those indexes in glucocorticoid group and non-glucocorticoid group had statistical differences (P ＜ 0.05).After treatment,CD3+ 、CD4+/CD8+ [CD3+:(47 ± 9) ％ vs (39 ±9)％,CD4+/CD8+:(1.8 ±0.5) vs(1.2 ±0.5),P ＜0.01].The CD8+ was lower[(18 ±7) ％ contrast with(28 ±8) ％,P ＜0.01].There were no statistical differences of IgA、IgG and IgM between glucocorticoid group and nonglucocorticoid group (P ＞ 0.05).Conclusions The immune response in the children with MPP is depressed,and the humoral immunity is in disorder.Small dose of glucocorticoid can effectivdy regulate the immune function.