人巨细胞病毒感染与儿童特发性血小板减少性紫癜的临床分析  

Clinical Analysis of Human Cytomegalovirus Infection and Idiopathic Thrombocytopenic Purpura in Children

作　　者：张勇刚 徐之良[1] 

机构地区：[1]武汉大学人民医院儿科,湖北武汉430000

出　　处：《四川医学》2017年第12期1428-1431,共4页Sichuan Medical Journal

摘　　要：目的了解急性特发性血小板减少性紫癜(Idiopathicthrombocytopenicpurpura,ITP)患儿不同人巨细胞病毒(human cytomegalovirus,HCMV)感染对象血清学检查结果和细胞免疫状态的差异,并分析不同ITP病情患儿血清学结果特征。方法回顾性分析2012年3月至2015年8月期间,在我院儿科进行住院治疗的53例急性特发性血小板减少性紫癜患儿,其中感染巨细胞病毒的患儿35例,未感染巨细胞病毒的患儿18例。比较两组对象血清学检查(CMV-DNA、CMV-Ig M、CMV-Ig G)、T细胞亚群检测结果(CD_3^+、CD4、CD_8^+)、细胞免疫状态(CD_3^+/CD_4^+、CD_3^+/CD_8^+、CD_3^+/CD_9^+、CD^+/CD^+_(56)、CD_4^+/CD_8^+)的差异,分析HCMV感染的不同病情的ITP患儿血清学检查结果的差别。结果两组患者基本情况构成的差异无统计意义;两组对象血清学检查结果的比较,CMV-DNA(=7.398,P=0.013)、CMV-Ig M(=20.164,P=0.000)、CMV-Ig G(=6.897,P=0.013)阳性检出率的差异均有统计学意义(P<0.05);不同ITP病情患儿血清学检查结果的比较,CMV-DNA(=14.243,P=0.034)、CMV-Ig G(=13.500,P=0.012)阳性检出率的差异均有统计学意义(P<0.05);两组对象T细胞亚群检测结果的比较,CD_3^+(t=2.233,P=0.030)、CD_4^+(t=11.546,P=0.000)、CD_8^+(t=7.414,P=0.000)含量的差异均有统计学意义(P<0.05)。两组对象细胞免疫状态的比较,CD_3^+/CD_4^+(t=2.661,P=0.010)、CD_3^+/CD_8^+(t=3.979,P=0.000)、CD_3^+/CD_9^+(t=2.091,P=0.042)、CD^+_(16)/CD^+_(56)(t=3.671,P=0.000)、CD_4^+/CD_8^+(t=4.342,P=0.000)的差异均有统计学意义(P<0.05)。结论人巨细胞病毒感染情况对ITP患儿血清学检查结果、T细胞亚群功能和免疫功能影响明显,而人巨细胞病毒感染对象的ITP病情严重程度对患儿血清学检查的结果影响明显。Objective To investigate the difference between the serological test results and the cellular immune status of different human cytomegalovirus （HCMV）infected children with acute idiopathic thrombocytopenic purpura （ITP）and analyze the characteristics of serological findings. Methods Retrospective analysis of 53 cases of acute idiopathic thrombocytopenic purpura children who received treatment in pediatric department in our hospital from March 2012 to August 2015 period, including 35 cases of children infected with cytomegalovirus and 18 cytomegalovirus free cases. The difference of serological findings （ CMV-DNA, ＋ ＋ ＋ ＋ ＋ ＋ ＋ CMV-IgM,CMV-IgG） ,T cell subsets（CD3 ,CO4 ,CDs ）and the cellular immune status（ CD3 /CD4 , CD3＋/CDs＋ , CD3/CD9 , CD ~6/CD s6, CD4＋/CD 8 ）in two groups were compared. The relation between the characteristics of serological findings and the se- verity of HCMV infection in children with ITP was analyzed. Results The baseline level was consistent in both groups. The com- parison of serological findings in two groups ： the difference of the positive detection rate of CMV-DNA （x = 7. 398, P = O. 013 ） , CMV-IgM （ Z2 = 20. 164, P = 0. 000）, CMV-IgG （ Z2 = 6. 897, P = 0. 013 ） were statistically significant （ P 〈 0. 05 ）. The comparison of CD3＋ （t = 2. 233 ,P =0. 030） ,CD4＋ （ t = 11. 546, P = 0. 000） and CDs （ t = 7. 414, P = 0. 000） were statistically significant（ P 〈 0. 05 ）. The ratio of some parameters in two groups, including CD3＋/CD4＋ （ t = 2. 661, P = O. 010 ）, CD3＋/CDs （ t = 3. 979, P = 0. 000） ,CD3＋/CO9＋ （t -- 2. 091 ,P =0. 042） ,CD16/CD56 （ t = 3. 671 ,P = 0. 000） and CD4/COs （ t =4. 342 ,P = 0. 000）, whichcould reflect the immune status, were statistically significant （P 〈 0. 05）. Conclusion The infection of human cytomegalovirus has significant effect on the serological test, T cell subsets function and immune function in children with ITP, and the severity of ITP in hu

关 键 词：人巨细胞病毒感染 儿童 急性特发性血小板减少性紫癜 血清学检查 免疫状态 

分 类 号：R725.5[医药卫生—儿科]