免疫反应及相关细胞因子在EV71 相关手足口病 合并肺水肿中的作用

目的:探讨细胞、体液免疫应答以及相关的细胞因子在EV71相关手足口病合并肺水肿中的作用。方法:将90例经鉴定为EV71感染患儿分为手足口病合并肺水肿组38例,手足口病无并发症组52例,并设查体健康对照组28例。ELISA法检测90例EV71感染引起的手足口病患儿血清IL-6、IL-10、TNF-α及IFN-γ含量;采用流式细胞仪对血液中CD3+T、CD4+及CD8+T细胞百分比进行检测;采用免疫比浊法对90例EV71感染引起的手足口病患儿血清免疫球蛋白(IgG、IgA及IgM)及补体C3、C4含量进行检测。结果:手足口病合并肺水肿组患儿血清IL-6、IL-10及IFN-γ含量明显升高,同时伴随CD4+及CD8+T细胞百分比下降;手足口病合并肺水肿组,无并发症组及健康对照组患儿血清IgM分别为1.85±0.73,1.46±0.790和0.88±0.39,三组之间差别具有统计学意义(F=14.967,P<0.05)。而IgG与IgA在三组之间无明显变化(X2=5.535,P>0.05;F=1.988,P>0.05);手足口病患儿血清C3及C4含量均明显低于健康对照组(F=46.079;62.794,P<0.05)。结论:由IL-10及IFN-γ的异常释放而引起的广泛的中枢及外周神经系统炎症反应和T淋巴细胞衰竭是引起EV71合并肺水肿病程进展的重要原因;在EV71感染后引发的手足口病进程中存在IgM的大量释放,且伴随补体C3、C4的消耗。

The Effect of Immunologic Response and Cytokine in Children with Pulmonary Edema after Enterovirus -71-Related Hand, Foot and Mouth Disease

Objective: To determine the effect of cellullar immunologic response,humoral reactions and cytokine in children with pulmonary edema after enterovirus-71-related hand,foot and mouth disease.Methods: Children who confirmed infected by enterovirus-71 were divided into two groups: 38 patients with pulmonary edema and 52 patients without complications.And 28 patients were considered as health control group.Serum IL-6,IL-10,TNF-α and IFN-γwere detected by ELISA.Flow cytometry was used to analyze the number of CD4+ and CD8+T cell in leukomonocyte suspension.And serum immunoglobin and complement(C3,C4) were detected by immunoturbidimetry.Results: A significant elevation of plasma interleukin(IL)-10 and interferon(IFN)-γlevels observed in patients with PE.Patients with PE also had lower circulating CD4+T cells and CD8+T cells.Serum IgM levels were 1.85±0.73 and 1.46±0.79 respectively in children in groups with complications and without complications,which significantly higher than that(0.88±0.39) in patients in controls(F=6.287,P<0.05).However,The IgG and IgA levels have no significant changes among the three groups(X2 = 5.535,P>0.05;F =1.988,P>0.05).Compared with patients in health control group,patients who experienced enterovirus-71 had decreasing C3 levels.So were serum levels of C4(F = 46.079;62.794,P <0.05).Conclusion: An extensive central and peripheral nervous system inflammatory response with abnormal IL-10,and IFN-γcytokine production and T lymphocyte decreasing appears to be responsible for the pathogenesis of EV71-associated PE.There have excessive immunoglobin production of IgM with decreasing C3 and C4 in patients with PE.