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目的研究婴儿感染巨细胞病毒(CMV)后体内胞外体(EXO)水平的变化,以及细胞因子IL-4、γ干扰素(IFN-γ)水平在CMV感染婴儿血清和(或)EXO中的变化,探讨CMV感染对婴儿免疫功能的影响以及EXO在CMV感染发生发展过程中的作用。方法选择山东大学齐鲁医院儿科收治的53例CMV感染婴儿(CMV感染组),排除其他病毒感染及遗传代谢性疾病;42例非CMV感染同龄儿童为对照组。分别采用ELISA法检测其血清EXO水平及血清EXO中IL-4水平,以及血清中IFN-γ水平。结果 CMV感染组患儿血清EXO、IFN-γ水平均较对照组显著降低(Pa<0.05),血清IL-4水平较对照组升高,但差异无统计学意义(P>0.05),EXO中IL-4水平较对照组显著升高(P<0.05);二组血清IL-4与EXO IL-4呈正相关(r=0.794,P=0.000),感染组血清IL-4与EXO IL-4呈显著正相关(r=0.902,P=0.000)。结论 1.CMV可破坏人体正常的Th1/Th2平衡,Th2免疫应答占优势,Th1免疫应答受抑制。2.CMV感染后,与Th1细胞相关的细胞因子IFN-γ减少,而与Th2细胞相关的细胞因子IL-4增多。3.EXO可作为细胞因子IL-4分泌的方式,介导机体细胞免疫功能的降低和Th1/Th2失衡,导致免疫耐受和免疫抑制,从而使病毒难以清除,感染持续并慢性化。
Objective To investigate the changes of exo (EXO) levels in infants infected with cytomegalovirus (CMV) and the levels of IL-4 and IFN-γ in infants with CMV infection and / or EXO To explore the impact of CMV infection on infant immune function and the role of EXO in the development of CMV infection. Methods Fifty-three infants with CMV infection (CMV infection group) were enrolled in pediatric department of Qilu Hospital of Shandong University to exclude other viral infections and genetic metabolic diseases. Forty-two non-CMV infected children of the same age as the control group. The level of serum EXO and the level of IL-4 in serum EXO and the level of IFN-γ in serum were detected by ELISA. Results The levels of serum EXO and IFN-γ in CMV infection group were significantly lower than those in control group (P <0.05), while the levels of serum IL-4 in CMV infection group were higher than those in control group (P> 0.05) The levels of IL-4 and EXO IL-4 in the two groups were significantly higher than those in the control group (r = 0.794, P = 0.000) There was a significant positive correlation (r = 0.902, P = 0.000). Conclusion 1. CMV can destroy the normal Th1 / Th2 balance in the human body, with the predominant Th2 immune response and the Th1 immune response suppressed. After CMV infection, Th1 cells associated with cytokine IFN-γ decreased, and Th2 cells associated with cytokine IL-4 increased. 3.EXO as a cytokine IL-4 secretion, mediated by the reduction of cellular immune function and Th1 / Th2 imbalance, leading to immune tolerance and immunosuppression, making the virus difficult to remove, the infection continued and chronic.