重症手足口病患儿T淋巴细胞亚群、NK细胞及细胞因子水平变化

岳　瑾; 冯晓靖; 黄振红; 王　芳

文章摘要

重症手足口病患儿T淋巴细胞亚群、NK细胞及细胞因子水平变化

Changes of T lymphocyte subsets,NK cells and cytokines in children with severe hand-foot-mouth disease

DOI：10.3969/j.issn.1007-8134.2021.05.014

中文关键词:

英文关键词: severe hand-foot-mouth disease children T lymphocyte subsets NK cell cytokines

基金项目:2018年度河南省医学科技攻关计划（2018020682）

作者	单位
岳　瑾	郑州大学附属儿童医院感染性疾病科
冯晓靖	郑州大学附属儿童医院感染性疾病科
黄振红	郑州大学附属儿童医院感染性疾病科
王　芳	郑州大学附属儿童医院感染性疾病科

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中文摘要:

目的　分析重症手足口病患儿外周血T淋巴细胞亚群、NK细胞及细胞因子水平变化及临床指导意义。方法　分析2018年1月—2020年4月在我院诊治的97例手足口病患儿资料，按病情分为重症组（25例），轻症组（72例）；纳入同期50例健康体检儿童为对照组。检测T淋巴细胞亚群（CD3+ T细胞、CD4+ T细胞、CD8+ T细胞）、NK细胞及细胞因子（TNF-α、IL-23、IL-22、IL-17）水平。对比上述指标在对照组、轻症组、重症组之间，重症组不同感染类型（Cox A16型、EV 71型、其他型）组间，重症组急性期组与恢复期组间及重症组预后不良组和预后良好组间的差异。分析4项细胞因子预测患儿预后的效能。结果　CD3+ T细胞、CD4+ T细胞、NK细胞水平从高到低均依次为对照组、轻症组、重症组，CD8+ T细胞水平从低到高依次为对照组、轻症组、重症组；血清TNF-α、IL-23、IL-22、IL-17水平从低到高均依次为对照组、轻症组、重症组。组间上述指标比较差异均具有统计学意义（P均＜0.05）。重症组不同感染类型组间T淋巴细胞亚群、NK细胞和细胞因子水平比较，差异均无统计学意义（P均＞0.05）。与恢复期组相比，急性期组CD3+ T细胞、CD4+ T细胞、NK细胞水平更低，CD8+ T细胞、TNF-α、IL-23、IL-22、IL-17水平更高，差异均具有统计学意义（P均＜0.05）。与预后良好组相比，预后不良组CD3+ T细胞、CD4+ T细胞、NK细胞水平更低，CD8+ T细胞、TNF-α、IL-23、IL-22、IL-17水平更高，差异均具有统计学意义（P均＜0.05）。4项细胞因子联合预测不良预后敏感度为83.33%，准确度为71.43%。结论　检测外周血T淋巴细胞亚群、NK细胞和细胞因子水平有助于手足口病病情判断，可对重症手足口病患儿进行预后预测。

英文摘要:

Objective　To analyze the changes of circulating T lymphocyte subsets, NK cells and cytokines in children with severe hand-foot-mouth disease and their guiding significance in clinical practice. Methods　Ninety-seven children with hand-foot-mouth disease who were admitted to our hospital from January 2018 to April 2020 were included in the study, and were divided into severe group (25 cases) and mild group (72 cases) according to the conditions. Fifty healthy children for physical examination were included as control group during the same period. The levels of T lymphocyte subsets (CD3+ T, CD4+ T, CD8+ T), NK cells and cytokines (TNF-α, IL-23, IL-22, IL-17) were detected. The above indicators of the control group, the mild group and the severe group were compared. The different infection types (Cox A16 type, EV 71 type, other infections) in the severe group were compared, and the differences between acute phase and recovery phase in the severe group, between the poor prognosis and the good prognosis in the severe group were also compared. The efficiency of 4 cytokines in predicting the prognosis was analyzed. Results　The levels of CD3+ T, CD4+ T and NK cells from high to low were arranged in an order of the control group, mild group and severe group. CD8+ T cells from low to high were arranged in an order of the control group, mild group, and severe group. Serum TNF-α, IL-23, IL-22, IL-17 levels from low to high were arranged in an order of the control group, mild group, and severe group. By comparisons, the above differences had statistical significance (P＜0.05). There were no statistically significant differences in T lymphocyte subsets, NK cells and cytokines of different infection types in severe group (P＞0.05). Compared with the recovery phase, the levels of CD3+ T, CD4+ T and NK cells in the acute phase of critically ill children were lower, while the levels of CD8+ T, TNF-α, IL-23, IL-22, IL-17 were higher (P＜0.05). Compared with the good prognosis group, the levels of CD3+ T, CD4+ T, NK cells were lower in the poor prognosis group, and the levels of CD8+ T, TNF-α, IL-23, IL-22, IL-17 were higher, with statistical significance (P＜0.05). The sensitivity and accuracy of 4 cytokines in predicting the prognosis were 83.33% and 71.43%, respectively. Conclusions　The detection of circulating T lymphocyte subsets, NK cells and cytokines is helpful for the judgment of hand-foot-mouth disease condition and predicts the prognosis of severe hand-foot-mouth children.

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