儿童传染性单核细胞增多症T细胞亚群的变化及其干预方法探讨

摘要

objective To investigate changes of T lymphocytes subsets in children with infectious mononucleosis(IM) and the effects of different interventions.Methods Forty-eisht children with IM were Twenty healthy children from healthcare clinic serviced as control group.Results CD4(%),CD8(%)and the CD4,CD8 ratio in healthy control group were(34.12±3.53)%,(26.22±4.43)%and(1.41±0.3),in IVIG group were(24.2±4.3)%,(36.4±6.8)%and(0.72±0.12),and in GCV group were(23.7±5.1)%, (37.3±7.8)%and(0.67±0.13),respectively.CD4(%),CD8(%)and the ratio CD4/CD8 in the control grouD were significantly different from those in both groups with IM(P<0.05).Compared with pre-tratment levels.the 28 cases treated with IVIG had significant improvement,the CD4(%)increased,CD8(%)decreased and the ratio of CD4/CD8 increased after treatment(P<0.05).However,20 cases in GCV treatment group made less chunges(P>0.05).Meanwhile,the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group(P<0.05).The rate of remission in IVIG group was 88.7%vs.59.2%of GcV group(P<0.05);the hospital days in IVIG grouP were(9.2±4.3)days vs.(13.8±5.1)days in tlle GCV (P<0.05).Conclusion It is indicated that the subsets of T lymphocytes in periphend blood are obviously abnormal in children with IM caused by EBV infection in acute phase.WIG can regulate the immunological derangements of T lymphoeytes subsets,on which anti-viral therapy alone may have little impact.%目的 探讨儿童传染性单核细胞增多症(IM)T细胞亚群的变化及免疫干预的有效性.方法 入选的48例患儿分为2组,治疗组患儿28例,用丙种球蛋白(IVIG)治疗,IVIG 400 mg/(kg·d),连用5 d;或IVIG 1g/(kg·d),连用2 d.对照组患儿20例,予更昔洛韦(GCV)5～10 mg/(kg·d)连用5 d.并予对症支持治疗.选择20例正常儿童作为健康对照.结果 健康儿童CD4(%)、CD8(%)及CD4/CD8比值分别为(34.12±3.53)%、(26.22±4.43)%及(1.41±0.3);IVIG组分别为(24.2±4.3)%、(36.4±6.8)%及(0.72±0.12);GCV组(23.7±5.1)%、(37.3±7.8)%及(0.67±0.13),健康对照组与两组IM患儿比较,差异有统计学意义(P<0.05);与治疗前比较,IVIG组患儿治疗后CD4(%)升高、CD8(%)下降及CD4/CD8比值升高(P<0.05);而GCV组患儿治疗前后上述指标无显著性变化(P>0.05);IVIG治疗组患儿临床症状及体征较GCV治疗组消失快(P<0.05),IVIG组患儿治疗有效率88.7%,GCV组患儿治疗有效率59.2%(χ2=3.97,P<0.05);IVIG组患儿平均住院日为(9.2±4.3)d,较GCV组(13.8±5.1)d明显缩短(t=-4.24,P<0.05);结论IM患儿除了病毒感染导致的直接影响外,存在明显的免疫功能紊乱;IVIG免疫干预治疗优于单纯抗病毒治疗.