EB病毒相关噬血细胞综合征患儿可溶性白细胞介素-2受体检测的意义  

Significance of Detection of Soluble Interleukin-2 Receptor for Epstein-Barr Virus Associated Hemophagocytic Syndrome in Children

作　　者：夏焱[1] 檀卫平[1] 刘勇[1] 陈肖嫦[1] 黄维肖[1] 李文益[1] 

机构地区：[1]中山大学附属第二医院儿科,广州510120

出　　处：《实用儿科临床杂志》2009年第22期1722-1725,共4页Journal of Applied Clinical Pediatrics

基　　金：广东省科技计划项目资助(2007B031508008);广东省自然科学基金项目资助(06300691)

摘　　要：目的探讨可溶性IL-2受体(sIL-2R)检测在EB病毒(EBV)相关噬血细胞综合征(HS)的应用价值。方法收集本院儿科诊治的HS患儿21例,分为复发组(6例)和缓解组(15例),采用ELISA法分别检测患儿血清sIL-2R EBV抗体4项[EBV壳抗原(VCA)-IgM、VCA-IgG、EBV早期抗原(EA)-IgG和EBV核抗原(EBNA)-1-IgG],荧光实时定量PCR检测患儿血浆EBV-DNA的表达,流式细胞术分析其淋巴细胞亚群(CD3+、CD4+、CD8+、CD+19、CD5+6)水平。结果HS患儿21例sIL-2R水平均超过2 400×103U/L;复发组和缓解组sIL-2R水平在初治时和诱导治疗结束时比较无统计学差异;维持治疗阶段缓解组sIL-2R水平明显下降(5 780×103U/L),与同期复发组(8 970×103U/L)比较差异有统计学意义(P<0.05)。21例患儿淋巴细胞亚群比例CD8+[(75.73±3.28)%]增高,CD56+[(9.23±3.18)%]和CD4+[(9.23±3.34)%]降低,在治疗期症状缓解后仍未恢复,复发组和缓解组组间无明显差异(P>0.05)。所有患儿EBV DNA PCR阳性,复发组和缓解组均有从低拷贝数至高拷贝数的病例,缓解治疗结束和维持治疗阶段仍可检测到EBV DNA[(3～4)×108copies/L],同期二组间无统计学差异(P>0.05)。复发组和缓解组EBV VCA-IgM、VCA-IgG和EA-IgG从初治期到维持治疗阶段均无明显差异,EBNA-1-IgG在维持治疗阶段部分转为阳性。结论结合EBV DNA和淋巴细胞亚群检测,追踪检查sIL-2R水平有利于区分HS的病情发展。Objective To explore the significance of detection of soluble IL-2 receptor（ sIL -2R） in differentiation of Epstein -Barr virus（EBV） associated hemophagocytic syndrome（HS） in children. Methods Twenty -one children with EBV associated HS were collected from the second hospital of Sun - Yat - Sen university. All patients were divided into 2 groups ： relapse group and remission group. The levels of sIL - 2R and EBV 4 antibodies [ viral capsid antigen （ VCA ） - IgM, VCA - IgG, Epstein - Barr virus early antigen EBV （EA） - IgG, Ep- stein - Barr virus nucleus antigen （EBNA） - 1 - IgG 1 in patients serum were detected by enzyme linked immunosorbent assay, EBV DNA in patients plasma were detected by real time PC R, the lymphocyte subpopulations were analyzed by flow cytometry （ CD3＋ , CD4＋ , CD8 ＋ , CD19＋, CD56＋ ）. Results The levels of slL - 2R were above 2 400 x 103 U/L in both groups ; there were no significantly differences at the time of ad- mission and remission, but the level of sIL- 2R in remission group （5 780 ×10^3 U/L）was significantly decreased compared to relapse group （8 970 ×10^3 U/L） during the continue treatment. There was high percentage of CD8 ＋ cells（75.73 ± 3.28 ） % and low percentage of CD56＋ （9.23± 3.18）% and CD4 ＋ cells（9.23± 3.34 ）% at the time of admission;and this abnormalities continued till remission and during the continue treatment. There were low and high copies of EBV DNA in two groups at beginning,and EBV DNA still were detectable[ （3 -4）×10^8 copies/L] in both groups after therapy. There also was no significantly difference of VCA -IgM, VCA -IgG and EA -IgG at the time of admission and remission ;but EBNA - 1 - IgG turned to positive in some cases of remission group during the continue treatment. Conclusions With detection of EBV - antibodies, EBV DNA and analysis of lymphocyte subpopulations, detection of sIL - 2R will be useful and possible for following up EBV associated HS.

关 键 词：EB病毒 可溶性白细胞介素-2受体 噬血细胞综合征 

分 类 号：R725.5[医药卫生—儿科]