可溶性白细胞介素-2受体检测在儿童EB病毒感染相关疾病中的应用价值  

Significance of soluble IL-2 receptor detection in Epstein-Barr virus-associated disorders in children

作　　者：夏焱[1] 刘勇[2] 郭海霞[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 [2]中山大学附属第二医院儿科血液研究室,广州510120

出　　处：《中国小儿血液与肿瘤杂志》2010年第5期203-207,228,共6页Journal of China Pediatric Blood and Cancer

基　　金：广东自然科学基金;编号06300691;广东省科技计划项目;编号2007B031508008

摘　　要：目的探讨可溶性白细胞介素(白介素)-2受体检测在儿童EB病毒(EBV)感染相关疾病鉴别诊断中的应用价值。方法将72例患儿分为IM组、IM转化EBV相关的噬血细胞淋巴组织细胞增生症(EBV-HLH)组和EBV-HLH组;采用酶联免疫吸附试验(ELISA)分别检测患儿血清可溶性白介素-2受体和EBV抗体四项(EBV壳抗原VCA-IgM、VCA-IgG和EBV早期抗原EA-IgG、EBV核抗原-1 EBNA-1-IgG),荧光实时定量PCR检测患儿血浆EBV-DNA的表达,流式细胞术分析淋巴细胞亚群(CD3,CD4,CD8,CD19,CD56)。结果 72例患儿急性期可溶性白介素-2受体水平均超过2 400 U/ml;IM转化组在急性期可溶性白介素-2受体水平仅轻度增高(4 320 U/ml),与IM组(3 310 U/ml)无明显差异,治疗后却明显增高(8 970 U/ml),并接近EBV-HLH组水平(11 230U/ml);EBV抗体四项显示IM转化组和EBV-HLH组在治疗后VCA-IgG和EA-IgG仍然持续高滴度,同时EBV核抗原-1-IgG仍持续阴性;三组急性期都有EBV-DNA拷贝数从低拷贝至高拷贝的病例,治疗后IM转化组和EBV-HLH组仍可检测到EBV-DNA(3×103~4×105copies/ml);IM转化组和EBV-HLH组CD8+细胞在治疗后仍持续较高水平[(61.32±4.63)%,(68.36±4.32)%],并同时出现NK细胞(CD56+)比例下降[(9.23±3.28)%,(10.52.±3.34)%]。结论结合EBV抗体、EBV-DNA和淋巴细胞亚群检测,可溶性白介素-2受体检查有可能成为追踪观察EBV感染相关疾病的指标之一。Objective To study the application of soluble IL-2 receptor detection in Epstein-Barr virus-associated disorders in children. Methods Patients were divided into three groups： infectious mononucleosis group （IM group） ; infectious mononucleosis transform group （IMT group） and hemoph- agocytic lymphohistiocytosis group （ HLH group）. ELISA was used to detect the serum levels of soluble IL-2 receptor （sIL-2R） and four antibodies to EBV （viral capsid antigen VCA-IgM^viral capsid antigen VCA-IgG^Epstein-Barr virus early antigen EBV EA-IgG and Epstein-Barr virus nucleus antigen EBNA-1 IgG）. EBV-DNA was measured by real time PCR, Moreover, the lymphocyte subpopulations （CD3, CIM, CD8, CD19, CD56） were analyzed by flow cytometry. Results The sIL-2R level was above 2 400 U/ml in all groups at acute phase, and was slight elevated in IMP group （4 320 U/ml） compared to IM group （3 310 U/ml）, but was dramatically increased after therapy （8 970 U/ml）, which almost approached the level of HLH group （ 11 230 U/ml）. IMT and HLH groups kept high titer of VCA-IgG and EA-IgG but negative EBNA-1 IgG after therapy; EBV-DNA copy numbers were from low to high in all groups at acute phase and were still detected in IMT and HLH group after therapy（3 x 103 s/ml ~4 x 105 copies/ml）. CD8 ＋ cells kept higher percentage [ （61.32 ±4.63）%, （68.36 ±4.32）% ] ,with lower NK cells [ （ CD56 ± 9.23±3.28） %, （ 10.52.±3.34） % ] in IMT and HLH groups after therapy. Conclusion Combined with EBV-antibodies, EBV-DNA and lymphocyte subpopulations analysis, soluble IL-2 receptor monitoring would be an effective index for following up EBV-associated disorders.

关 键 词：EB病毒 白细胞介素-2受体 可溶性 传染性单核细胞增多症 淋巴组织细胞增多症 嗜血细胞性 

分 类 号：R446.6[医药卫生—诊断学]