目的：检测难治性肺炎支原体肺炎（RMPP）患儿支气管肺泡灌洗液（BALF）中IL-4、INF-γ水平，探讨RMPP患儿病变局部Th1、Th2型细胞因子水平的变化及其意义。方法：选择RMPP患儿（42例）为研究对象。根据是否有湿疹、过敏性鼻炎、荨麻疹及相关过敏性疾病家族史等将42例RMPP患儿分为特应性组（11例）和非特应性组（31例）。以同期因支气管异物住院、异物取出4周后纤维支气管镜复查的患儿为对照组（12例）。对RMPP患儿及对照患儿BALF中细胞学成分进行分析，并采用ELISA方法检测BALF中IL-4、INF-γ水平。结果：与对照组比较，RMPP组患儿BALF中细胞总数上升（P0.05）。结论：RMPP患儿BALF细胞数显著增加，尤以中性粒细胞为甚。RMPP患儿BALF中INF-γ、IL-4水平明显升高，但INF-γ/IL-4比值无变化，提示RMPP患儿病变局部炎症反应明显，但尚不能证实RMPP患儿存在Th2占主导的炎症反应。
Abstract
OBJECTIVE: To measure levels of interleukin-4 (IL-4) and interferon-gamma (INF-γ) in the bronchoalveolar lavage fluid (BALF) of children with refractory Mycoplasma pneumoniae pneumonia (RMPP), and to investigate changes in local Th1-Th2-type cytokine levels in children with RMPP and their significance. METHODS: A total of 42 children with RMPP were divided into atopic (n=11) and non-atopic groups (n=31) according to whether they had eczema, allergic rhinitis, urticaria, and family history of allergic disease. The study also included a control group of 12 children with bronchial foreign bodies who underwent foreign body removal and were re-examined by fiberoptic bronchoscopy four weeks later. The different cells in BALF from all children were analyzed, and the levels of IL-4 and INF-γ in BALF were measured using enzyme-linked immunosorbent assay. RESULTS: Compared with the control group, the total number of cells in BALF from children with RMPP increased significantly (P0.05). CONCLUSIONS: Significant increase in cell numbers, especially neutrophils, as well as IL-4 and INF-γ levels, can be seen in BALF from children with RMPP, but there is no change to the INF-γ/IL-4 ratio. This indicates a significant local inflammatory response in children with RMPP, but there is no evidence of Th2-dominated inflammatory response.
关键词
难治性肺炎支原体肺炎 /
支气管肺泡灌洗液 /
白细胞介素 /
干扰素 /
儿童
Key words
Refractory Mycoplasma pneumoniae pneumonia /
Bronchoalveolar lavage fluid /
Interleukin /
Interferon /
Child
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参考文献
［1］Ou CY, Tseng YF, Chiou YH, Nong BR, Huang YF, Hsieh KS. The role of Mycoplasma pneumoniae in acute exacerbation of asthma in children［J］. Acta Paediatr Taiwan, 2008, 49(1): 14-18.
［2］Kraft M, Cassell GH, Henson JE, Watson H, Williamson J, Marmion BP, et al. Detection of Mycoplasma pneumoniae in the airways of adults with chronic asthma［J］. Am J Respir Crit Care Med, 1998, 158(3): 998-1001.
［3］Waites KB, Balish MF, Atkinson TP. New insights into the pathogenesis and detection of Mycoplasma pneumoniae infections［J］. Future Microbiol, 2008, 3(6): 635-648.
［4］Waites KB. New concepts of Mycoplasma pneumonia infections in children［J］. Pediatric Pulmonol, 2003, 36(4): 267-278.
［5］胡亚美, 江载芳. 诸福棠实用儿科学［M］. 第7版. 北京:人民卫生出版社, 2002:1180.
［6］中华医学会儿科学分会呼吸学组, 中华几科杂志编辑委员会. 儿童社区获得性肺炎管理指南(试行)(下)［J］. 中华儿科杂志, 2007,45(3):225-226.
［7］曹兰芳.儿童难治性肺炎支原体肺炎的诊治现状和进展［J］. 临床儿科杂志, 2010,28(1):94-97.
［8］Stelmach I, Podsiadlowicz-Borzecka M, Grzelewski T, Majak P, Stelmach W, Jerzyńska J, et al. Humoral and cellular immunity in children with Mycoplasma pneumoniae infection: a 1-year prospective study［J］. Clin Diagn Lab Immunol, 2005, 12(10): 1246-1250.
［9］刘芳. 肺炎支原体肺炎患儿支气管肺泡灌洗液T细胞活化状态的变化及意义［D］. 浙江大学医学院，2009.
［10］吴淑慧, 孙武, 郭建国. 支气管哮喘与细胞免疫［J］. 国际呼吸杂志, 2007, 27(15): 1193-1196.
［11］吴健, 徐军, 钟南山. BCG与变应性哮喘Th1/Th2平衡［J］. 国外医学(呼吸系统分册), 2001, 21 (3):151-156.
［12］Koh YY, Park Y, Lee HJ, Kim CK. Levels of interleukin-2, interferon-g, and interleukin-4 in bronchoalveolar lavage fluid from patients with mycoplasma pneumonia: implication of tendency toward increased immunoglobulin E production［J］. Pediatrics, 2001, 107(3): E39.
［13］潘薇, 许忠, 郑百红. 肺炎支原体肺炎患儿急性期外周血INF-γ、IL-4的变化［J］. 中国当代儿科杂志, 2006, 8(5):373-375.
［14］Choi IS, Byeon JH, Yoo Y, Lee KC, Choung JT. Increased serum interleukin5 and vascular endothelial growth factor in children with acute mycoplasma pneumonia and wheeze［J］. Pediatr Pulmonol, 2009, 44(5): 423-428.
［15］左慧敏, 刘秀云, 江载芳. 白介素-8、白介素-10及γ-干扰素在肺炎支原体肺炎中的作用［J］. 中国实用儿科杂志, 2008, 23(4):269-271.
［16］Chu HW, Honour JM, Rawlinson CA, Harbeck RJ, Martin RJ. Effects of respiratory Mycoplasma pneumoniae infection on allergen-induced bronchial hyperresponsiveness and lung inflammation in mice［J］. Infect Immun, 2003, 71(3): 1520-1526.
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