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目的探讨新生儿巨细胞病毒肺炎血清细胞因子IL-4、IFN-γ、TNF-α水平及意义。方法选取25例确诊为新生儿巨细胞病毒肺炎,并将其分为丙种球蛋白治疗组和更昔洛韦治疗组,应用ELISA法检测治疗前和疗程结束后血清细胞因子IL-4、IFN-γ、TNF-α的浓度,另选取本院产科同期出生的足月正常新生儿15例为正常对照组,用相同的方法检测其血清中细胞因子IL-4、IFN-γ、TNF-α的浓度。结果相对于健康新生儿,CMV-IgM阳性患儿血清IFN-γ及TNF-α水平升高,差异有统计学意义(t值分别为2.65及3.16,P<0.05);而IL-4水平降低,差异有统计学意义(t=2.49,P<0.05)。丙种球蛋白治疗组(IVIG)和更昔洛韦治疗组治疗前IFN-γ、IL-4、TNF-α水平比较,差异无显著性(t值分别为1.85、1.71及1.76,P<0.05);IVIG治疗组中,治疗前后比较,IFN-γ及TNF-α水平降低,差异有统计学意义(t值分别为3.98及5.16,P<0.01);而IL-4水平升高,差异有统计学意义(t=2.55,P<0.05)。更昔洛韦治疗组中,治疗前后比较,IFN-γ及TNF-α水平变化不明显,差异无统计学意义(t值分别为1.75及1.16,P>0.05);而IL-4水平无明显降低,差异无统计学意义(t=1.89,P>0.05)。结论巨细胞病毒肺炎新生儿Th1/Th2存在平衡失调,代表Th1细胞功能水平的细胞因子IFN-γ水平明显增高,呈现低水平的Th1相对优势,表明感染后,免疫平衡遭到破坏,细胞因子分泌失衡,造成机体的免疫炎症损伤,IVIG治疗可以纠正这一平衡失调,提示在新生儿巨细胞病毒肺炎除单一抗病原治疗外,应重视免疫调节治疗。
Objective To investigate the levels of serum cytokines IL-4, IFN-γ and TNF-α in neonatal cytomegalovirus pneumonia. Methods Twenty-five neonates with cytomegalovirus pneumonia were selected and divided into gamma globulin treatment group and ganciclovir treatment group. Serum cytokines IL-4 and IFN-γ were measured by ELISA before and after treatment. γ and TNF-α in serum and other 15 normal newborn infants born in obstetrics at the same period were selected as the normal control group. Serum levels of IL-4, IFN-γ, TNF-α concentration. Results The serum levels of IFN-γ and TNF-α in CMV-IgM positive children were significantly higher than those in healthy newborns (t = 2.65 and 3.16, respectively, P <0.05) , The difference was statistically significant (t = 2.49, P <0.05). There were no significant differences in the levels of IFN-γ, IL-4 and TNF-α before and after treatment with IVIG and ganciclovir (t = 1.85,1.71 and 1.76, P <0.05) ; The levels of IFN-γ and TNF-α in IVIG treatment group before and after treatment decreased significantly (t = 3.98 and 5.16 respectively, P <0.01), while the levels of IL-4 increased Significance (t = 2.55, P <0.05). There was no significant difference in the levels of IFN-γ and TNF-α between the two groups (t = 1.75 and 1.16, respectively, P> 0.05), while the level of IL-4 in the ganciclovir group was not significantly different Reduce, the difference was not statistically significant (t = 1.89, P> 0.05). Conclusions Th1 / Th2 in neonates with cytomegalovirus pneumonia is imbalanced. The level of cytokine IFN-γ, which represents the functional level of Th1 cells, is significantly increased, showing a relatively low level of Th1 relative advantage, indicating that the immune balance is destroyed after infection and cytokine secretion Imbalance, resulting in the body’s immune inflammatory damage, IVIG treatment can correct this imbalance, suggesting that in addition to a single anti-pathogen treatment of neonatal cytomegalovirus pneumonia should pay attention to immunomodulatory treatment.