儿童传染性单核细胞增多症T细胞亚群的变化及其干预方法探讨  

Significance of changes of T lymphocytes subsets in children with infectious mononucleosis and the effects of different interventions

作　　者：陈壮桂[1] 李鸣[2] 纪经智[1] 陈虹[1] 陈岩峰[1] 陈奋华[1] 

机构地区：[1]中山大学附属第三医院儿科,广州510630 [2]中山大学附属第一医院黄埔院区呼吸内科,广州510630

出　　处：《中华实验和临床病毒学杂志》2009年第2期118-120,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的探讨儿童传染性单核细胞增多症（IM）T细胞亚群的变化及免疫干预的有效性。方法入选的48例患儿分为2组，治疗组患儿28例，用丙种球蛋白（WIG）治疗，IVIG400mg／（kg·d），连用5d；或IVIG1g／（kg·d），连用2d。对照组患儿20例，予更昔洛韦（GCV）5～10mg／（kg·d）连用5d。并予对症支持治疗。选择20例正常儿童作为健康对照。结果健康儿童CD4（％）、CD8（％）及CD4／CD8比值分别为（34．12±3．53）％、（26．22±4．43）％及（1．41±0．3）；IVIG组分别为（24．2±4．3）％、（36．4±6．8）％及（0．72±0．12）；GCV组（23．7±5．1）％、（37．3±7．8）％及（0．67±0．13），健康对照组与两组IM患儿比较，差异有统计学意义（P〈0．05）；与治疗前比较，IVIG组患儿治疗后CD4（％）升高、CD8（％）下降及CD4／CD8比值升高（P〈0．05）；而GCV组患儿治疗前后上述指标无显著性变化（P〉0．05）；IVIG治疗组患儿临床症状及体征较GCV治疗组消失快（P〈0．05），IVIG组患儿治疗有效率88．7％，GCV组患儿治疗有效率59．2％（X2=3．97，P〈0．05）；IVIG组患儿平均住院日为（9．2±4．3）d，较GCV组（13．8±5．1）d明显缩短（t=-4．24，P〈0．05）；结论IM患儿除了病毒感染导致的直接影响外，存在明显的免疫功能紊乱；IVIG免疫干预治疗优于单纯抗病毒治疗。Objective To investigate changes of T lymphocytes subsets in children with infectious mononucleosis （IM） and the effects of different interventions. Methods Forty-eight children with IM were enrolled, 28 cases were assigned to the group treated with intravenous immunoglobulin （IVIG） 400 mg/（kg·d） for 5 continuous days or [VIG 1 g/（kg·d） for 2 continuous days, the remaining 20 cases were treated with ganciclovir （GCV） 5-10 mg/（kg·d） for 5 consecutive days. All these children were given general supportive therapies. Twenty healthy children from healthcare clinic serviced as control group. Results CIM （ % ）, CD8 （ % ） and the C IM/CD8 ratio in healthy control group were （34.12 ±3.53） %, （26.22 ±4.43） % and （1.41 ± 0.3）, in IVIG group were （24. 2±4.3）%, （36.4±6.8）% and （0.72 ± 0.12）, and in GCV group were （23.7 ＋ 5.1）%, （37.3 ± 7.8） % and （0.67± 0.13）, respectively. CD4 （ % ）, CD8 （ % ） and the ratio CD4/CD8 in the control group were significantly different from those in both groups with IM （P 〈 0.05 ）. Compared with pre-treatment levels, the 28 cases treated with IVIG had significant improvement, the CD4（ % ） increased, CDS（ % ） decreased and the ratio of CIM/CDg increased after treatment （ P 〈 0.05）. However, 20 cases in GCV treatment group made less changes （P 〉 0.05）. Meanwhile, the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group （P 〈 0.05）. The rate of remission in IVIG group was 88.7% vs. 59.2% of GCV group （ P 〈 0.05） ; the hospital days in IVIG group were （9.2 ± 4.3） days vs. （ 13. 8 ± 5.1 ） days in the GCV （P 〈 0.05 ）. Conclusion It is indicated that the subsets of T lymphocytes in peripheral blood are obviously abnormal in children with IM caused by EBV infection in acute phase. IVIG can regulate the immunological derangements of T lymphocytes subsets, on which anti-viral therapy alone may have little impact.

关 键 词：传染性单核细胞增多症 疱疹病毒4型 人 T淋巴细胞亚群 丙种球蛋白类 更昔洛韦 

分 类 号：R725.1[医药卫生—儿科]