穿孔素和颗粒酶B在儿童传染性单核细胞增多症肝损伤中的表达及意义  

Association of perforin and granzyme B with liver injury induced by infectious mononucleosis in Children

作　　者：姜涛[1] 李黎平 易思思[2] 欧阳文献[1] 谭艳芳[1] 李双杰[1] JIANG Tao;LI Liping;YI Sisi(Liver Research Center,Hunan Children＇s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院肝病中心,长沙410007 [2]湖南省儿童医院儿科医学研究所,长沙410007

出　　处：《临床肝胆病杂志》2018年第9期1956-1959,共4页Journal of Clinical Hepatology

基　　金：湖南省卫生厅课题(C2015-59)

摘　　要：目的观察传染性单核细胞增多症(IM)患儿外周血单个核细胞(PBMC)中CD8+T淋巴细胞和NK细胞中穿孔素及颗粒酶B的变化,探索其在肝损伤中的临床意义。方法选择2016年1月-2017年6月在湖南省儿童医院住院且符合IM诊断标准的患儿60例,以30例健康儿童志愿者为对照组;通过细胞表面标记和细胞内细胞因子染色技术,采用流式细胞术分析PBMC中CD8+T淋巴细胞和NK细胞及其穿孔素及颗粒酶B的表达。计量资料2组间比较采用t检验,3组间比较采用单因素方差分析,进一步两两比较采用Dunnett-t法。结果在60例IM患儿中,肝损伤发生率50%(30/60),其中ALT<200 U/L者60%(18/30),200 U/L≤ALT<400 U/L者33.3%(10/30),ALT≥400 U/L者6.67%(2/30),所有患儿经治疗1个月后复查肝功能均恢复正常。与正常组相比,IM非肝损伤和肝损伤组CD8+T淋巴细胞中穿孔素和颗粒酶B的表达均明显升高(P值均<0.05)。与IM非肝损伤组相比,肝损伤组中CD8+T淋巴细胞表达水平及NK细胞中穿孔素和颗粒酶B的表达均明显升高(P值均<0.05)。结论 IM患儿肝损伤发生率高,主要为轻中度转氨酶升高,能自限性恢复正常,NK细胞中穿孔素和颗粒酶B及CD8+T淋巴细胞高表达是造成IM肝损伤的原因。Objective To investigate the changes in peripheral blood mononuclear cells [CD8＋T lymphocytes and natural killer（NK）cells] and levels of perforin and granzyme B in these cells in children with infectious mononucleosis（IM）,as well as their clinical significance in liver injury. Methods A total of 60 children who met the diagnostic criteria for IM were enrolled,and 30 healthy children were enrolled as control group. With the help of cell surface markers and cytokine staining,flow cytometry was performed to analyze CD8＋T lymphocytes,NK cells,and the expression of perforin and granzyme B. The t-test was used for comparison of continuous data between groups;a one-way analysis of variance was used for comparison between three groups,and the Dunnett-t test was used for further comparison between two groups. Results Among the 60 children with IM,the incidence rate of liver injury was 50%（30/60）; 18（60%） children had an alanine aminotransferase（ALT） level of 〈200 IU/L,10（33. 3%） had an ALT level of ≥200 IU/L and 〈 400 IU/L,and 2（6. 67%）had an ALT level of ≥400 IU/L. All children had normal liver functions after one month of treatment. Compared with the control group,the non-liver injury IM group and the liver injury IM group had significant increases in the expression of perforin and granzyme B in CD8＋T lymphocytes（all P〈0. 05）. Compared with the non-liver injury subgroup of IM patients,the liver injury subgroup had a significantly higher percentage of CD8＋T lymphocytes and significantly higher expression of perforin and granzyme B in NK cells（all P〈0. 05）. Conclusion There is a high incidence rate of liver injury in children with IM,mainly mild or moderate elevation of aminotransferases,which are self-limiting and can be returned to normal. High levels of perforin and granzyme B in NK cells and a high percentage of CD8＋T lymphocytes are the cause of liver injury.

关 键 词：疱疹病毒4型 人 传染性单核细胞增多症 穿孔素 颗粒酶类 儿童 

分 类 号：R512.7[医药卫生—内科学]