屈曉，于春梅，房玉輝，田廣燕

作者單位：250022山東省濟(jì)南市，山東大學(xué)齊魯兒童醫(yī)院神經(jīng)內(nèi)科

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重癥病毒性腦炎患兒T淋巴細(xì)胞亞群變化及其臨床意義分析

屈曉，于春梅，房玉輝，田廣燕

作者單位：250022山東省濟(jì)南市，山東大學(xué)齊魯兒童醫(yī)院神經(jīng)內(nèi)科

【摘要】目的觀察重癥病毒性腦炎患兒T淋巴細(xì)胞亞群變化，探討其臨床意義。方法選取2009年6月—2012年6月山東大學(xué)齊魯兒童醫(yī)院收治的病毒性腦炎患兒60例，其中輕、重型患兒各30例，分別作為輕型組、重型組。同時選取健康兒童30例作為對照組。輕型組患兒給予常規(guī)治療，重型組患兒在常規(guī)治療基礎(chǔ)上給予大劑量甲潑尼龍聯(lián)合丙種球蛋白治療。比較3組受試者T淋巴細(xì)胞亞群及重型組不同預(yù)后患兒治療前后T淋巴細(xì)胞亞群。結(jié)果輕型組患兒C、C、C細(xì)胞分?jǐn)?shù)及C/C細(xì)胞比值與對照組比較，差異均無統(tǒng)計學(xué)意義(P>0.05)；重型組患兒C、C細(xì)胞分?jǐn)?shù)均低于對照組、輕型組，C細(xì)胞分?jǐn)?shù)、C/C細(xì)胞比值均高于對照組、輕型組(P<0.05)。重型組預(yù)后良好患兒治療后C、C細(xì)胞分?jǐn)?shù)及C/C細(xì)胞比值均高于治療前，C細(xì)胞分?jǐn)?shù)低于治療前(P<0.05)；重型組預(yù)后不良患兒治療后C、C細(xì)胞分?jǐn)?shù)及C/C細(xì)胞比值高于治療前(P<0.05)，而治療前后C細(xì)胞分?jǐn)?shù)比較，差異無統(tǒng)計學(xué)意義(P>0.05)。結(jié)論重癥病毒性腦炎患兒常伴有T淋巴細(xì)胞亞群改變，檢測重癥病毒性腦炎患兒T淋巴細(xì)胞亞群有助于判斷病情嚴(yán)重程度及預(yù)后效果。

小兒病毒性腦炎是兒科常見中樞神經(jīng)系統(tǒng)感染性疾病，其發(fā)病率高，臨床表現(xiàn)十分復(fù)雜。多數(shù)病毒性腦炎患兒經(jīng)治療會獲得良好預(yù)后，但重癥病毒性腦炎患兒易出現(xiàn)后遺癥，嚴(yán)重影響患兒身體健康[1]。因此，早期診斷并積極治療對促進(jìn)病毒性腦炎患兒的康復(fù)至關(guān)重要。本研究旨在探討重癥病毒性腦炎患兒T淋巴細(xì)胞亞群變化及其臨床意義。

1　資料與方法

1.1一般資料選取2009年6月—2012年6月山東大學(xué)齊魯兒童醫(yī)院收治的病毒性腦炎患兒60例，其中輕、重型患兒各30例，分別作為輕型組、重型組。輕型病毒性腦炎診斷標(biāo)準(zhǔn)：(1)起病急，發(fā)病前2周內(nèi)伴有腸道感染或呼吸道感染，并明確為病毒感染，如輪狀病毒陽性等；(2)顱腦CT及MRI檢查顯示異?；蚰X電圖顯示異常；(3)腰椎穿刺結(jié)果與病毒性腦炎改變相符；(4)臨床表現(xiàn)為腦膜或腦實質(zhì)損害，如意識障礙、肢體癱瘓、腦膜刺激征、失語等；(5)排除中毒性腦病、結(jié)核性腦膜炎、化膿性腦膜炎等其他中樞神經(jīng)系統(tǒng)感染性疾病。重型病毒性腦炎診斷標(biāo)準(zhǔn)與輕型病毒性腦炎的診斷一致并滿足以下條目中至少2條[2]：(1)昏迷等精神癥狀及意識改變十分明顯；(2)反復(fù)、持續(xù)出現(xiàn)驚厥或抽搐癥狀；(3)無自主呼吸或呼吸節(jié)律發(fā)生改變；(4)癱瘓或肌張力異常，伴有肢體運(yùn)動功能障礙。輕型組中男12例，女18例；年齡1～12歲，平均年齡(6.5±2.1)歲。重型組中男13例，女17例；年齡1～13歲，平均年齡(6.6±1.9)歲。同時選取本院體檢中心健康兒童30例為對照組，其中男10例，女20例；年齡8個月～12歲，平均年齡(6.4±2.0)歲。3組受試者性別、年齡間具有均衡性。

1.2治療方法輕型組患兒給予控制高熱抽搐、抗病毒及脫水降顱內(nèi)壓等常規(guī)處理。重型組患兒在常規(guī)治療基礎(chǔ)上采用甲潑尼龍20 mg·kg-1·d-1進(jìn)行沖擊治療，用藥3 d后減量至1～2 mg·kg-1·d-1，治療3～5 d；同時大劑量靜脈輸注丙種球蛋白1 g·kg-1·d-1，治療2 d，驚厥頻繁者聯(lián)合丙戊酸鈉進(jìn)行治療。

1.3觀察指標(biāo)收集3組受試者入院后晨起空腹靜脈血，其中重型組患兒在治療結(jié)束1周后再次采集靜脈血，采用FACSCalibur流式細(xì)胞儀(美國BD公司生產(chǎn))測定T淋巴細(xì)胞亞群。比較3組受試者T淋巴細(xì)胞亞群及重型組不同預(yù)后患兒治療前后T淋巴細(xì)胞亞群，以出院后無明顯神經(jīng)系統(tǒng)癥狀者為預(yù)后良好，死亡或遺留神經(jīng)系統(tǒng)功能障礙者為預(yù)后不良。

2　結(jié)果

表1　3組受試者T淋巴細(xì)胞亞群比較(±s)

注：與重型組比較，aP<0.05

Table 2Comparison of T-lymphocyte subsets before and after treatment in severe viral encephalitis children with good prognosis

時間例數(shù)CD+3細(xì)胞分?jǐn)?shù)(%)CD+4細(xì)胞分?jǐn)?shù)(%)CD+8細(xì)胞分?jǐn)?shù)(%)CD+4/CD+8細(xì)胞比值治療前1662.5±2.430.5±3.631.1±3.81.0±0.3治療后1666.3±3.141.2±4.123.9±2.61.7±0.5t值3.8777.8446.4294.802P值<0.05<0.05<0.05<0.05

Table 3Comparison of T-lymphocyte subsets before and after treatment in severe viral encephalitis children with poor prognosis

時間例數(shù)CD+3細(xì)胞分?jǐn)?shù)(%)CD+4細(xì)胞分?jǐn)?shù)(%)CD+8細(xì)胞分?jǐn)?shù)(%)CD+4/CD+8細(xì)胞比值治療前1462.5±2.430.5±3.631.1±3.81.0±0.3治療后1465.3±3.140.2±4.129.9±2.61.6±0.5t值3.7777.7446.3284.702P值<0.05<0.05>0.05<0.05

3　討論

小兒病毒性腦炎主要由機(jī)體細(xì)胞免疫功能降低及病毒感染引起，是兒科常見中樞神經(jīng)系統(tǒng)感染性疾病。皰疹病毒、腸道病毒等病原體侵入機(jī)體及中樞神經(jīng)系統(tǒng)后，會造成神經(jīng)元及血管內(nèi)皮細(xì)胞損傷，繼而引起腦組織損傷及循環(huán)障礙，可導(dǎo)致抽搐、發(fā)熱、頭疼等臨床癥狀[3]。病毒性腦炎一經(jīng)確診必須及時進(jìn)行治療，以免病情加重而引發(fā)運(yùn)動障礙、智力障礙及癲癇等[4]。因此，應(yīng)加強(qiáng)小兒病毒性腦炎患兒的對癥治療及抗病毒治療。

綜上所述，重癥病毒性腦炎患兒常伴有T淋巴細(xì)胞亞群改變，檢測重癥病毒性腦炎患兒T淋巴細(xì)胞亞群有助于判斷病情嚴(yán)重程度及預(yù)后效果。

參考文獻(xiàn)

[1]呂建軍,龐寶東,曹麗華，等.丙種球蛋白對病毒性腦炎患兒免疫球蛋白、細(xì)胞因子及T細(xì)胞亞群的影響[J].山東醫(yī)藥,2011,51(23):106-107.

[2]孫浩,韓虹,唐宇暉，等.手足口病合并病毒性腦炎126例患兒外周血T淋巴細(xì)胞亞群及體液免疫臨床分析[J].山西醫(yī)藥雜志,2012,41(19):1019-1020.

[3]趙華鋒,姜萍,段全紀(jì)，等.小兒病毒性腦炎外周血T淋巴細(xì)胞亞群和腦脊液免疫球蛋白水平的動態(tài)觀察[J].中國醫(yī)藥導(dǎo)刊,2010,12(10):1765-1766.

[4]Lejeune M,Miro JM,De Lazzari E,et al.Restoration of T cell responses to toxoplasma gondii after successful combined antiretroviral therapy in patients with AIDS with previous toxoplasmic encephalitis.[J].Clin Infect Dis,2011,52(5):662-670.

[5]屈曉,李志毅,劉勇，等.喜炎平聯(lián)合阿糖腺苷對小兒病毒性腦炎患者T細(xì)胞亞群的影響及其療效觀察[J].中國生化藥物雜志,2015,(3):131-133.

(本文編輯：崔沙沙)

·臨床研究·

【關(guān)鍵詞】腦炎，病毒性；兒童；T淋巴細(xì)胞亞群

屈曉，于春梅，房玉輝，等.重癥病毒性腦炎患兒T淋巴細(xì)胞亞群變化及其臨床意義分析[J].實用心腦肺血管病雜志，2015，23(9)：139-141.[www.syxnf.net]

Qu X, Yu CM, Fang YH, et al.Changes and clinical significances of T - lymphocyte subsets in children with viral encephalitis[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2015，23(9)：139-141.

Changes and Clinical Significances of T-lymphocyte Subsets in Children with Viral EncephalitisQUXiao,YUChun-mei,FANGYu-hui，etal.DepartmentofNeurology，QiluChildren′sHospital，ShandongUniversity，Ji′nan250022,China

【Abstract】ObjectiveTo observe the changes of T-lymphocyte subsets in children with viral encephalitis，to explore their clinical significances.MethodsFrom June 2009 to June 2012，a total of 60 children with viral encephalitis were selected in Qilu Children′s Hospital，Shandong University，including 30 cases with mild viral encephalitis(A group),30 cases with severe viral encephalitis(B group).A total of 30 healthy children were selected as control group at the same time.Children of A group were given routine treatment,while children of B group were given extra large dose of methylprednisolone and gamma globulin based on routine treatment.T-lymphocyte subsets was compared among the three groups，while before and after treatment，T-lymphocyte subsets was compared between severe viral encephalitis children with good prognosis and with poor prognosis.ResultsNo statistically significant differences of C cell percentage,C cell percentage,C cell percentage or C/C cell ratio was found between A group and control group(P>0.05);C cell percentage and C cell percentage of B group were statistically significantly lower than those of A group and control group，while C cell percentage and C/C cell ratio of B group were statistically significantly higher than those of A group and control group(P<0.05).Of B group，C cell percentage,C cell percentage and C/C cell ratio after treatment of children with good prognosis were statistically higher than those before treatment，while C cell percentage after treatment was statistically significantly lower than that before treatment(P<0.05)；C cell percentage,C cell percentage and C/C cell ratio after treatment of children with poor prognosis were statistically higher than those before treatment(P<0.05)，but no statistically significant differences of C cell percentage was found before and after treatment(P>0.05).ConclusionT-lymphocyte subsets of children with severe viral encephalitis are usually abnormal，detection of T-lymphocyte subsets has some significances in guiding the judgement of disease severity and prognosis.

【Key words】Encephalitis, viral；Child；T-lymphocyte subsets

收稿日期：(2015-07-21；修回日期：2015-09-10)

【中圖分類號】R 725.123

【文獻(xiàn)標(biāo)識碼】B

doi:10.3969/j.issn.1008-5971.2015.09.048

通信作者：田廣燕，250022山東省濟(jì)南市，山東大學(xué)齊魯兒童醫(yī)院神經(jīng)內(nèi)科；E-mail：1391484882@qq.com