手足口病合并神经源性肺水肿患儿T淋巴细胞亚群、免疫球蛋白及锌水平变化及其临床意义

摘要

目的：：探讨手足口病(HFMD)合并神经源性肺水肿(NPE)患儿外周血 T 淋巴细胞亚群、免疫球蛋白及锌水平的变化及临床意义.方法：选取2015年1月~2016年5月我院收治的重症 HFMD 患儿68例进行观察,依据患者是否并发 NPE 分为 NPE 组25例及重症组43例,检测2组患儿入院1、3、5 d外周血 T 淋巴细胞亚群、免疫球蛋白及红细胞锌水平.结果：NPE 组 CD3＋、CD4＋明显低于重症组, CD8＋明显高于重症组(P ＜0．05),CD4＋/CD8＋比值在入院1 d、3 d 时成倒置状态,入院5d 时基本恢复正常；NPE 组 IgG、IgA 水平在入院第1~5 d 均低于重症组(P ＜0．05),2组间 IgM 水平无显著差异(P ＞0．05)；NPE 组随着病情的进展锌水平呈现下降趋势(P ＜0．05),NPE 组入院各时间点锌水平均明显低于重症组(P ＜0．05).结论：机体免疫功能紊乱是导致 HFMD 并发 NPE 疾病进展的重要机制,红细胞锌浓度的检测可对患儿病情的严重程度做出辅助判断.%Objective:To explore the changes of peripheral blood T lymphocyte subsets,immunoglobulin,and zinc lev-els,and their clinical significance in children with hand-foot-mouth disease (HFMD)merged with neurogenic pulmonary edema (NPE).Methods:A total of 68 children with severe HFMD who were admitted in our hospital from January,201 5 to May, 201 6 were included in the study and divided into NPE group (n= 25 )and severe group (n=43)according to whether being complicated with NPE or not.The peripheral blood T lymphocyte subsets,immunoglobulin,and erythrocyte zinc levels 1,3, and 5d after admission in the two groups were detected.Results:CD3+ and CD4+ levels in NPE group were significantly low-er than those in the severe group,while CD8+ level was significantly higher than that in the severe group (P <0.05).CD4+/CD8+ was in a inverted state 1 d and 3 d after admission,and was basically recovered normal 5 d after admission.IgG and IgA levels 1-5 d after admission in NPE group were significantly lower than those in the severe group (P <0.05),and the difference of IgM level between the two groups was not statistically significant (P > 0.05 ).With the disease progression,zinc level in NPE group was significantly reduced (P <0.05).Zinc level at each timing point in NPE group was significantly lower than that in the severe group (P <0.05).Conclusions:The immune dysfunction is an important mechanism for causing NPE in children with HFMD.Detection of erythrocyte zinc concentration can help estimate the severity degree.