川崎病患儿T细胞免疫功能的变化及临床意义

摘要

Objective:To observe the changes of T lymphocyte subsets and relative cytokines in infants with kawasaki disease (KD)and to observe their significance in process of KD.Methods:A total of 55 infants with KD were selected as KD group,while 47 infants with non-KD in corresponding period served as non-KD group,and another 40 healthy infants undergoing physical examinations as control group.Flow cytometer (FCM)was used to detect the ratios of peripheral blood CD3 +,CD3 +CD4 +,CD3 +CD8 +,CD3 +CD19 +,CD4 +/CD8 +and CD4 +CD25 +in all groups and analyze the curve characters of receiver operating characteristic (ROC). Enzyme-linked immuno sorbent assay (ELISA)was applied to detect the levels of serum interleukin 6 (IL-6),IL-1βand tumor necro-sis factor-α(TNF-α)in all groups.Results:KD group was evidently lower in the ratios of peripheral blood CD3 +,CD3 +CD8 +and CD4 +CD25 +,but markedly higher in the ratios of CD3 +CD4 +,CD3 +CD19 +and CD4 +/CD8 +than other two groups (P<0.01).KD group was notably higher in levels of serum TNF-α,IL-1βand IL-6 than other two groups (P<0.01),whereas non-KD groups was significantly higher in levels of IL-1βand IL-6 than control group (P<0.01).The diagnostic critical values of ROC curves of CD3 +,CD3 +CD4 +,CD3 +CD8 +,CD3 +CD19 +,CD4 +/CD8 +and CD4 +CD25 +were 54.5%,28.6%,20.4%,26.1%, 1.8% and 6.0% respectively.Conclusion:Infants with KD have imbalance of T lymphocyte subsets marked by reduced CD4 +CD25+and CD3 +CD8 +,increased ratios of CD3 +CD4 +,CD3 +CD19 +and CD4 +/CD8 +as well as levels of IL-6,TNF-αand IL-1β,which may participate in the pathological process of KD.%目的：观察川崎病（kawasaki disease，KD）患儿体内 T淋巴细胞亚群及相关细胞因子的变化，分析其在 KD 发病中的意义。方法：选取 KD患儿55例设为 KD组，同期住院的普通发热非 KD患儿47例设为非 KD 组，另选取同期门诊体检的健康儿童40例设为对照组。使用流式细胞仪检测各组儿童外周血 CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD3＋CD19＋、CD4＋／CD8＋、CD4＋CD25＋比例，分析 ROC 曲线特征。使用 ELISA法检测各组儿童血清白介素6（IL-6）、IL-1β及肿瘤坏死因子α（TNF-α）水平。结果：KD急性期患儿组外周血 CD3＋、CD3＋CD8＋、CD4＋CD25＋比例低于非 KD 组及对照组；CD3＋CD4＋、CD3＋CD19＋、CD4＋／CD8＋比例高于另两组（P＜0．01）。KD 组患儿血清 TNF-α、IL-1β及 IL-6水平明显高于非KD组及对照组（P＜0．01），非 KD组 IL-1β及 IL-6水平高于对照组（P＜0．01）。KD患儿 CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD3＋CD19＋、CD4＋／CD8＋、CD4＋CD25＋ROC 曲线对 KD 的诊断界值分别为54．5％、28．6％、20．4％、26．1％、1．8％、6．0％。结论：KD患儿体内存在 T淋巴细胞亚群失衡，表现为 CD4＋CD25＋、CD3＋CD8＋减少，CD3＋CD4＋、CD3＋CD19＋比例及 CD4＋／CD8＋比值升高，且 IL-6、TNF-α、IL-1β等细胞因子水平升高，可能参与了 KD病理过程。