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目的探讨丙种球蛋白输注对川崎病患儿外周血CD4~+CD25~+调节T细胞(Treg)与淋巴细胞亚群分布的影响及临床意义。方法流式细胞术检测40例川崎病患儿和30例体检健康儿童外周血中CD4~+CD25~+Treg细胞的表达水平以及108例川崎病患儿和41例体检健康儿童外周血中淋巴细胞亚群分布。ELISA法检测川崎病患儿血浆中TGF-β1浓度。108例川崎病患儿中有30例收集到对应的丙种球蛋白(IVIG)治疗后全血,流式细胞术检测CD4~+CD25~+Treg、TGF-β1及淋巴细胞亚群在川崎病患儿丙种球蛋白(IVIG)治疗前后表达水平的差异。结果与健康体检组相比,川崎病患儿CD4~+CD25~+Treg细胞及血浆TGF-β1的表达水平明显降低,外周血CD3+、CD8~+T细胞及NK细胞的表达水平明显降低,CD4~+T细胞、B细胞及CD4~+/CD8~+水平明显增高,差异均有统计学意义(均P<0.01)。与IVIG治疗前相比,川崎病患儿IVIG治疗后外周血CD4~+CD25~+Treg细胞及血浆TGF-β1的表达水平明显增高(均P<0.05),外周血CD3+、CD8~+T细胞及NK细胞的表达水平明显增高(均P<0.05),CD4~+T细胞、B细胞及CD4~+/CD8~+水平明显降低(均P<0.05)。治疗后患儿外周血CD4~+CD25~+Treg水平、血浆TGF-β1浓度及淋巴细胞亚群表达水平与健康对照相比无差异(P>0.05)。结论 Treg细胞与淋巴细胞比例失常是导致儿童川崎病免疫紊乱的重要原因。检测CD4~+CD25~+调节T细胞及淋巴细胞亚群分布对评估川崎病患儿的细胞免疫状况,辅助诊断和指导治疗具有重要的临床价值。
Objective To investigate the effect of gamma globulin infusion on the distribution of CD4 ~ + CD25 ~ + regulatory T cells (Tregs) and lymphocyte subsets in children with Kawasaki disease and its clinical significance. Methods Flow cytometry was used to detect the levels of CD4 ~ + CD25 ~ + Treg cells in peripheral blood of 40 children with Kawasaki disease and 30 healthy children and 108 children with Kawasaki disease and 41 healthy children with peripheral blood lymphocytes Subpopulation distribution. The level of TGF-β1 in children with Kawasaki disease was measured by ELISA. Thirty cases of 108 Kawasaki disease children were collected for the corresponding whole blood after IVIG treatment. The levels of CD4 ~ + CD25 ~ + Treg, TGF-β1 and lymphocyte subsets were detected by flow cytometry in patients with Kawasaki disease Differences in the expression levels of gamma globulin (IVIG) before and after treatment. Results Compared with the healthy group, the expression of CD4 ~ + CD25 ~ + Treg cells and plasma TGF-β1 in children with Kawasaki disease were significantly decreased, while the expression of CD3 +, CD8 ~ + T cells and NK cells in peripheral blood were significantly decreased ~ + T cells, B cells and CD4 ~ + / CD8 ~ + levels were significantly increased, the differences were statistically significant (P <0.01). The levels of CD4 ~ + CD25 ~ + Treg cells and plasma TGF-β1 in peripheral blood of children with Kawasaki disease after IVIG treatment were significantly higher than those before IVIG treatment (all P <0.05). The levels of CD3 +, CD8 + T cells (P <0.05). The levels of CD4 ~ + T cells, B cells and CD4 ~ + / CD8 ~ + were significantly decreased (all P <0.05). The levels of CD4 ~ + CD25 ~ + Treg, plasma TGF-β1 and lymphocyte subsets in peripheral blood of children after treatment were not significantly different from those of healthy controls (P> 0.05). Conclusion The abnormal proportion of Treg cells and lymphocytes is an important cause of Kawasaki disease in children. Detection of CD4 ~ + CD25 ~ + regulatory T cells and lymphocyte subsets distribution in children with Kawasaki disease evaluation of cellular immune status, diagnosis and guidance of treatment has important clinical value.