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目的探讨T细胞亚群选择性缺失及体液免疫变化在儿童重症手足口病发生发展中的作用,为临床治疗及预后评估提供依据。方法选取2010年5月-2013年5月该院PICU收治的重症手足口病患儿185例及同期在门诊治疗的普通手足口病患儿32例为研究对象,将上述患儿分为危重组(37例)、重症组(148例)和普通组(32例)。采用流式细胞仪检测各组儿童CD3~+、CD4~+、CD8~+、CD19~+、CD56~+及CD4~+/CD8~+水平,应用单向免疫扩散法测定其血清IgG、IgM、IgA、C_3及C_4水平。比较各组患儿细胞免疫(T细胞亚群)及体液免疫(IgG、IgM、IgA)水平的差异。结果 3组患儿CD3~+、CD4~+、CD19~+T细胞数量及CD4~+/CD8~+比较,差异有统计学意义(P<0.05)。CD8~+及CD56~+T细胞数量比较,差异无统计学意义(P>0.05)。3组患儿IgG、IgM、IgA均存在异常,差异有统计学意义(P<0.05)。结论 T细胞亚群选择性缺失及体液免疫变化在儿童手足口病发生发展中起关键作用,T细胞免疫功能抑制与重症手足口病的不良预后相关。
Objective To investigate the role of selective deletion of T cell subsets and humoral immunity in the occurrence and development of severe hand-foot-mouth disease in children and provide the basis for clinical treatment and prognosis evaluation. Methods From May 2010 to May 2013, 185 children with severe hand-foot-mouth disease admitted to PICU hospital and 32 children with HFMD during the same period were enrolled in this study. The children were divided into critical group (37 cases), severe group (148 cases) and general group (32 cases). The levels of CD3 +, CD4 +, CD8 +, CD19 +, CD56 + and CD4 + / CD8 + were detected by flow cytometry in all groups. Serum IgG and IgM levels were measured by one-way immunodiffusion , IgA, C_3 and C_4 levels. The differences of cellular immunity (T cell subsets) and humoral immunity (IgG, IgM, IgA) between children in each group were compared. Results The number of CD3 ~ +, CD4 ~ +, CD19 ~ + T cells and CD4 ~ + / CD8 ~ + in the three groups were significantly different (P <0.05). There was no significant difference in the number of CD8 ~ + and CD56 ~ + T cells (P> 0.05). There were abnormalities of IgG, IgM and IgA in the three groups, with statistical significance (P <0.05). Conclusions The selective deletion of T cell subsets and humoral immune changes play a key role in the development of HFMD in children. The suppression of T cell immune function is associated with the poor prognosis of HFMD.