标题：婴幼儿重症肺炎免疫球蛋白、T淋巴细胞亚群的变化及临床意义

      作者：邓建荣 1，林小芹 2    (1.粤北人民医院儿科，广东 韶关 512026；2.韶关市第一人民医院儿童康复科，广东 韶关 512000)

      卷次： 2018年29卷22期

      【摘要】 目的 探讨婴幼儿重症肺炎免疫球蛋白、T淋巴细胞亚群的变化及临床意义。方法 收集粤北人民医院儿科2016年6月至2018年6月收治的52例重症肺炎婴幼儿，依据小儿危重病例评分(PCIS)分组，≤70分为极危重组(n=22)，70~80分为危重组(n=30)，选取20例健康儿童作为对照组，比较两组重症肺炎患儿治疗前及恢复期的血清免疫球蛋白(IgG、IgM、IgA)及T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平，并与对照组进行比较。结果 外周血 IgG、IgM、IgA在对照组[(10.34±1.32) g/L、(1.44±0.15) g/L、(1.99±0.67) g/L]、危重组[(7.74±0.82) g/L、(0.75±0.24) g/L、(0.85±0.07) g/L]、极危重组[(6.38±0.75) g/L、(0.49±0.06) g/L、(0.78±0.08) g/L]间依次降低，三组比较差异均有统计学意义(P<0.05)；外周血CD3+、CD4+，CD4+/CD8+在对照组[(61.86±11.95)%、(38.60±1.51)%、(1.71±0.06)%]、危重组[(55.86±2.63)%、（30.58±3.22)%、(1.21±0.07)%]、极危重组[(51.28±9.13)%，(25.39±3.69)%、(0.88±0.09)% ]间依次降低，三组比较差异均有统计学意义(P<0.05)；外周血CD8+在对照组、危重组、极危重组分别为(22.67±2.87)%、(29.97±1.77)%、(33.26±3.90)%，依次升高，三组比较差异有统计学意义(P<0.05)；危重组和极危重组恢复期外周血 IgG、IgM、IgA、CD3+、CD4+、CD4+/CD8+均明显高于急性期，CD8+均明显低于急性期，两组比较，差异均有统计学意义(P<0.05)。结论 婴幼儿重症肺炎存在体液和细胞免疫功能紊乱，病情越重免疫功能越低下，因此免疫球蛋白及T淋巴细胞亚群的变化可有效判断肺炎患儿的病情、疗效及预后。
      【关键词】 重症肺炎；免疫球蛋白；T淋巴细胞亚群；免疫功能；危重病例评分
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2018）22—3173—04

Changes and clinical significance of immunoglobulin and T lymphocyte subsets in children with severepneumonia.
DENG Jian-rong 1, LIN Xiao-qin 2. 1. Department of Pediatrics, Yuebei People's Hospital, Shaoguan 512026,Guangdong, CHINA; 2. Department of Children's Rehabilitation, Shaoguan First People's Hospital, Shaoguan 512000,Guangdong, CHINA
【Abstract】 Objective To investigate the changes and clinical significance of immunoglobulin and T lympho-cyte subsets in children with severe pneumonia. Methods A total of 22 children with severe pneumonia and 30 chil-dren with mild pneumonia treated in Department of Pediatrics, Yuebei People's Hospital during June 2016 to June 2018were selected and divided into critical group (n=30) and extremely critical group (n=22) according to the pediatric criti-cal illness score (PCIS). At the same time, 20 healthy children were selected and included into the control group. Thelevel of serum immunoglobulin (IgG, IgM, IgA) and T drenching in different groups were compared. The level of(CD3+, CD4+, CD8+, CD4+/CD8+) was measured. The test was carried out again in the recovery period of severe pneu-monia. Results The peripheral blood IgG, IgM, IgA were (10.34±1.32) g/L, (1.44±0.15) g/L, (1.99±0.67) g/L in thecontrol group, (7.74±0.82) g/L, (0.75±0.24) g/L, (0.85±0.07) g/L in the critical group and (6.38±0.75) g/L, (0.49±0.06) g/L,(0.78±0.08) g/L in extremely critical group, which were decreased successively in the three groups, with statistically sig-nificant differences (P<0.05). The peripheral blood CD3+, CD4+, CD4+/CD8+ were (61.86±11.95)%, (38.60±11.51)%,(1.71±0.06)% in the control group, (55.86±7.63)%, (30.58±3.22)%, (1.21±0.07)% in the critical group, and (51.28±9.13)%, (25.39±3.69)%, (0.88±0.09)% in the extremely critical group, which decreased successively in the three groups,with statistically significant differences (P<0.05). The peripheral blood CD8+ was (22.67±2.87)% in the control group,(29.97±1.77)% in the critical group and (33.26±3.90)% in the extremely critical group, which was increased successivelyin the three groups, with statistically significant difference (P<0.05). The peripheral blood IgG, IgM, IgA, CD3+, CD4+and CD4+/CD8+ in the convalescence phase were significantly higher than those in the acute stage, and the CD8+ weresignificantly lower (P<0.05). Conclusion There is a disorder of cellular and humoral immune function in children withsevere pneumonia. The clinical monitoring of immune state, such as the changes of immunoglobulin and T lymphocytesubsets, can effectively judge the condition, curative effect and prognosis of children with pneumonia.
      【Key words】 Severe pneumonia; Immunoglobulin; T lymphocyte subsets; Immune function; Pediatric critical ill-ness score (PCIS)·论 著·doi:10.3969/j.issn.1003-6350.2018.22.020