560例手足口病患儿细胞免疫的变化

目的探讨手足口病患儿细胞免疫功能与病情严重程度的关系及随病情恢复的变化。方法收集560例手足口病患儿临床资料，按有无合并脑炎分为2组，重症病例组（脑炎组）360例，普通病例组（无脑炎组）200例，并选取同期本院儿保科进行体检的健康儿童120例为正常对照组，对照组在体检时，病例组分别于入院2h内（急性期）、治疗1周后（恢复期）进行T细胞亚群（CD3＋，CD4＋，CD8＋）百分率及血清IgG、IgA、IgM水平检测，分析各组细胞免疫水平的差异，比较重症病例组和普通病例组急性期及恢复期的细胞免疫改善程度。结果560例手足口病患儿中普通病例组CoxA16阳性率（72．0％）高于重症组（5．0％，X2=280．72，P〈0．01），而重症病例组EV71（70．3％）及其它病毒阳性率（7．2％）高于普通病例组（20．5％，X2=127．75，P〈0．01；2．5％，x2=5．43，P〈0．05）；普通病例组、重症病例组的细胞免疫与正常对照组比较差异有统计学意义（t=9．82，4．98，3．06，P〈0．01）；普通病例组、重症病例组入院2h内与．1周后（恢复期）复查CD3＋，CD4＋，CD8＋，比较差异有统计学意义（普通病例组t=7．73，3．86，4．71，P〈0．01，重症病例组t=6．13，2．60，3．36，P〈0．01）；普通病例组与重症病例组比较，普通病例组1周前后细胞免疫改善更明显（t=2．57，2．51，2．95），差异均有统计学意义（P〈0．05）。结论手足口病患儿未合并脑炎者病原学检测以CoxA16阳性率高，合并脑炎者EV71及其它病毒阳性率高；两组患儿病初细胞免疫功能降低，治疗1周后细胞免疫功能均明显恢复，且与临床症状轻重有关。

The changes of cellular immunity in 560 cases of hand-foot-mouth disease children

Objective To investigate the relationship of cellular immunity of the hand-foot-mouth disease （HFMD） children and the disease severity and the variation following the recovery of disease. Methods A total of 560 HFMD cases was collected , and divided into severe and common groups. Another 120 cases were collected for comparison. T cell subsets （ CD3＋ , CD4 ＋ , and CD8 ＋ ） rates were tested. The difference in cell immunity in each group were compared, and the comparison of cell immunity improve- ment during acute and recovery periods was conducted at the same time. Results In the 560 cases of chil- dren with HFMD, CoxA16 -positive rate in common group was higher than that in severe group （X2 = 280.72, P 〈0. 01, severe cases） ; EV71 and other virus positive rates in severe group were higher than that in common group （ X2 = 127.75, P 〈 0. 01, X2 = 5.43, P 〈 0. 05 ）. Cell immunity was compared a- mong 3 groups （ t = 9. 82,4. 98, 3.06） ; CD3 ~ , CD4 ＊ , CD8 ＋results, tested within 2h after admission and after 1 week, were compared between severe and common groups （ common group t = 7.73, 3.86, 4. 71 ; severe group t = 6. 13, 2. 60 , 3.36 ）. Compared to severe group, cell immunity improvement was more obvious between before and after l-week treatment in common group （ t = 2. 57, 2. 51, 2. 95 ）. The difference was statistically significant （ P 〈 0. 05）. Conclusions According to the etiology test of children with HFMD, CoxA16 -positive rate was higher in common group; EV71 and other virus positive rates were higher in severe group. Cell immunity function decreased in severe and common group at the beginning of the disease; it was, however, significantly restored after 1-week treatment; and it was related to the severityof clinical symptoms.