
T淋巴细胞亚群及过敏原与婴幼儿肺炎支原体感染伴喘息的关系
丁林, 季伟, 孙慧明, 蒋吴君, 顾文婧, 严永东, 邵雪军
中国当代儿科杂志 ›› 2016, Vol. 18 ›› Issue (12) : 1254-1258.
T淋巴细胞亚群及过敏原与婴幼儿肺炎支原体感染伴喘息的关系
Association of T lymphocyte subsets and allergens with Mycoplasma pneumoniae infection complicated by wheezing in infants and young children
目的 分析肺炎支原体 (MP)感染伴喘息婴幼儿的T淋巴细胞亚群表达及过敏原筛查情况。方法 流式细胞仪检测354例MP感染伴喘息婴幼儿 (MP喘息组)、336例MP感染不伴喘息婴幼儿 (MP非喘息组)、277例反复喘息患儿 (反复喘息组)的外周血T淋巴细胞亚群表达,同时进行过敏原检测。结果 MP喘息组和反复喘息组的CD3+及CD3+CD8+淋巴细胞百分比均低于MP非喘息组 (P < 0.05);MP喘息组和MP非喘息组的CD3+CD4+淋巴细胞百分比均高于反复喘息组 (P < 0.05);MP喘息组和反复喘息组的CD3-CD19+及CD19+CD23+淋巴细胞百分比均明显高于MP非喘息组 (P < 0.05),以反复喘息组最高 (P < 0.05)。食入性过敏原检测总阳性率 (30.3%)高于吸入性过敏原 (14.7%),P < 0.05;反复喘息组、MP喘息组的食入性和吸入性过敏原阳性率均高于MP非喘息组,以反复喘息组最高 (P < 0.05)。结论 T淋巴细胞亚群紊乱、过敏体质在MP感染伴喘息的婴幼儿发病起着重要作用。
Objective To investigate the percentage of T lymphocyte subsets and allergen screening results in infants and young children with Mycoplasma pneumoniae (MP) infection complicated by wheezing. Methods Flow cytometry was used to measure the percentage of peripheral blood T cell subsets in 354 infants and young children with MP infection complicated by wheezing (MP wheezing group), 336 infants and young children with MP infection but without wheezing (MP non-wheezing group), and 277 children with recurrent wheezing (recurrent wheezing group). Allergen screening was also performed for these children. Results Both the MP wheezing group and recurrent wheezing group had significantly lower percentages of CD3+ and CD3+CD8+ lymphocytes than the MP non-wheezing group (P < 0.05). The MP groups with or without wheezing had a significantly higher percentage of CD3+CD4+ lymphocytes than the recurrent wheezing group (P < 0.05). Both the MP wheezing group and recurrent wheezing group had significantly higher percentages of CD3-CD19+ and CD19+CD23+ lymphocytes than the MP non-wheezing group (P < 0.05), and the recurrent wheezing group had the highest percentages (P < 0.05). The overall positive rate of food allergens was significantly higher than that of inhaled allergens (30.3% vs 14.7%;P < 0.05). The positive rates of food and inhaled allergens in the recurrent wheezing group and MP wheezing group were significantly higher than in the MP non-wheezing group (P < 0.05), and the recurrent wheezing group had the highest rates. Conclusions Imbalance of T lymphocyte subsets and allergic constitution play important roles in the pathogenesis of MP infection complicated by wheezing in infants and young children.
肺炎支原体 / 喘息 / T淋巴细胞亚群 / 过敏 / 婴幼儿
Mycoplasma pneumoniae / Wheezing / T lymphocyte subset / Allergy / Infant and young child
[1] Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children[J]. N Engl J Med, 2015, 372(9):835-845.
[2] Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children:update 2011[J]. Thorax, 2011, 66(Suppl 2):ii1-23.
[3] Wood PR, Hill VL, Burks ML, et al. Mycoplasma pneumoniae in children with acute and refractory asthma[J]. Ann Allergy Asthma Immunol, 2013, 110(5):328-334.
[4] Martinez FD. Development of wheezing disorders and asthma in preschool children[J]. Pediatrics, 2002, 109(2 Suppl):362-367.
[5] Choi IS, Byeon JH, Yoo Y, et al. Increased serum interleukin-5 and vascular endothelial growth factor in children with acute mycoplasma pneumonia and wheeze[J]. Pediatr Pulmonol, 2009, 44(5):423-428.
[6] 中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南[J]. 中华儿科杂志, 2008, 46(10):745-753.
[7] 申昆玲,江载芳.其他微生物所致肺炎[M]//胡亚美,江载芳.诸福棠实用儿科学. 第7版. 北京:人民卫生出版社, 2002:1204-1205.
[8] Guo Q, Li HY, Zhou YP, et al. Associations of radiological features in Mycoplasma pneumoniae pneumonia[J]. Arch Med Sci, 2014, 10(4):725-732.
[9] 吕婕, 范亚可, 董晓艳, 等. 伴喘息症状的肺炎患儿临床及病原学研究[J]. 中国当代儿科杂志, 2005, 7(3):259-260.
[10] 严永东, 王宇清, 陈正荣, 等. 婴幼儿喘息与呼吸道病毒、肺炎支原体、肺炎衣原体感染及过敏的关系[J]. 苏州大学学报(医学版), 2009, 29(3):577-579.
[11] Watson ME Jr, Storch GA. Recurrent Mycoplasma pneumoniae infection in a human immunodeficiency virus-positive child[J]. Pediatr Infect Dis J, 2008, 27(11):1037-1038.
[12] 孙红, 孙红妹. 肺炎支原体直接损伤及其免疫学致病机制研究进展[J]. 中华微生物学和免疫学杂志, 2015, 35(1):65-68.
[13] 陈广道, 陈爱欢. 儿童肺炎支原体感染相关喘息的研究进展[J]. 中华儿科杂志, 2012, 50(10):756-759.
[14] Esposito S, Blasi F, Arosio C, et al. Importance of acute Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with wheezing[J]. Eur Respir J, 2000, 16(6):1142-1146.
[15] Chung HL, Kim SG, Shin IH. The relationship between serum endothelin (ET)-1 and wheezing status in the children with Mycoplasma pneumoniae pneumonia[J]. Pediatr Allergy Immunol, 2006, 17(4):285-290.
[16] 何学华, 李云, 易红玲. 肺炎支原体肺炎患儿血清T-IgE和ECP检测及临床意义[J]. 中国当代儿科杂志, 2003, 5(5):475-476.
[17] 罗晓明, 杜立中, 周馥英, 等. 外周血CD23表达阳性B淋巴细胞对婴幼儿喘息预后的早期预测作用[J]. 中国实用儿科杂志, 2004, 19(1):16-18.
[18] Bodhankar S, Sun X, Woolard MD, et al. Interferon gamma and interleukin 4 have contrasting effects on immunopathology and the development of protective adaptive immunity against mycoplasma respiratory disease[J]. J Infect Dis, 2010, 202(1):39-51.
[19] 倪慧萍, 季伟, 陈正荣, 等. 肺炎支原体肺炎患儿T淋巴细胞亚群表达及临床意义[J]. 江苏医药,2012, 38(22):2705-2707.
[20] Pedersen SE, Hurd SS, Lemanske RF Jr, et al. Global strategy for the diagnosis and management of asthma in children 5 years and younger[J]. Pediatr Pulmonol, 2011, 46(1):1-17.
[21] Yeh JJ, Wang YC, Hsu WH, et al. Incident asthma and Mycoplasma pneumoniae:A nationwide cohort study[J]. J Allergy Clin Immunol, 2016, 137(4):1017-1023.
[22] 陈彩霞, 单晔, 葛蕾, 等. 婴幼儿喘息与呼吸道合胞病毒肺炎支原体感染及过敏的关系[J]. 中国实用儿科杂志, 2007, 22(12):908-910.
[23] 盛冬青, 李世艳, 孙新民. 支原体肺炎患儿的喘息症状、气道高反应性与过敏史、血清总IgE水平的关系探讨[J]. 华中医学杂志, 2000, 24(6):314-315.
国家自然科学基金(8157010146)。