呼吸道合胞病毒毛细支气管炎患儿中性粒细胞活化及蛋白酶平衡的研究  

Neutrophfl activation and protease imbalance in respiratory tract of infants with respiratory syncytial virus bronchiolitis

作　　者：刘金玲[1] 陈志敏[1] 

机构地区：[1]浙江大学医学院附属儿童医院呼吸科,杭州310031

出　　处：《中华医学杂志》2009年第6期397-399,共3页National Medical Journal of China

基　　金：浙江省科技计划项目（2003C33007）

摘　　要：目的探讨呼吸道合胞病毒毛细支气管炎（毛支）气道局部中性粒细胞活化及蛋白酶平衡状况。方法收集符合毛支诊断标准的住院患儿30例，根据入院Lowell评分，≥10分为重度组（11例），〈10分为轻度组（19例）；20例治疗7—12d后症状缓解采取标本作为恢复组，细菌性肺炎（肺炎）组24例，对照组15例。测定各组鼻咽吸出物中性粒细胞弹性蛋白酶（NE）、白细胞介素（IL）-8浓度、α1，抗胰蛋白酶（α1AT）和蛋白酶抑制力。结果毛支组中性粒细胞比例、NE、IL-8浓度（0．528、6．39×10^7kg／L、13．62×10^9kg／L）均明显高于对照组（0．074、2．53×10^7kg／L、2．64×10^9kg／L，均P〈0．05）和恢复组（0．306、1．23×10^7kg／L、5．95×10^9kg／L，均P〈0．05）。恢复组中性粒细胞比例和IL-8浓度仍高于对照组（均P〈0．05），重度毛支组该两项指标均高于轻度组（均P〈0．05）。毛支组仪，AT表达高于恢复组（0．49比0．09，P〈0．05），与对照组（0．26）比较差异无统计学意义。毛支组出现游离NE活性为6／30，与肺炎组7／24比较，差异无统计学意义（P〉0．05）。结论呼吸道合胞病毒毛支气道局部存在大量中性粒细胞聚集活化和蛋白酶系统失衡，并可能在其发病中起重要作用。Objective To better understand the neutrophil activation and protease imbalance in respiratory syncytial virus （RSV） bronchiolitis. Methods Pediatric patients with RSV bronchiolitis were collected, 11 with the Lowell scores ≥ 10 （severe group ） , and 19 with the Lowell scores 〈 10 （mild group ）. 20 RSV bronchiolitis patients in convalescent group, 24 patients with bacterial pneumonia, and 15 patients as control group. The percentages of neutrophils were detected. ELISA was used to detect the concentration of neutrophil elastase （NE） and interleukin （IL）-8, and the elastase inhibition capacity （EIC）/free neutrophil elastase activity were detected by colorimetry. Immunohistochemistry was used to examine the expression of eq antitrypsin （α1 AT） . Results The neutrophil percentage, the NE and IL-8 concentration of the RSV bronchiolitis group（0. 528,6.39 × 10^7 kg/L and 13.62 × 10^9 kg/L）were all significantly higher than those of the control（0.074,2.53 × 10^7 kg/L and 2.64 × 10^9 kg/L） and convalescent groups（0. 306, 1.23 × 10^7 kg/L and 5.95 × 10^9 kg/L, all P 〈 0.05）. The neutrophil percetage and IL-8 concentration of the convalescent group were both significantly higher than those of the control group （ both P 〈 0.05 ）. Increased expression of oL1 AT in RSV bronchiolitis was found when compared with convalesent infants （0.49 vs 0.09, P 〈 0.05 ）. The free elastase activity level of the bronchiolitis group was 6/30, not different with 7/24 of pneumonia group, and it was only one in convalesent infants. Conclusion Mass of neutrophil aggregation and activation exist in RSV bronchiolitis, as well as protease system imbalance, and may play an important role in the inflammatory response and pathogenesis of RSV bronchiolitis.

关 键 词：呼吸道合胞体病毒感染 细支气管炎 Α1抗胰蛋白酶 

分 类 号：R686[医药卫生—骨科学]