重症手足口病患儿血清细胞因子检测分析

目的探讨重症手足口病(HFMD)患儿血清多种细胞因子的变化水平,了解患儿的免疫功能状态。方法重症HFMD患儿34例,根据病情分为重型组和危重型2组;选择16例健康儿童作为对照组。总结HFMD患儿的临床特点,进行病原学检测,同时采用Luminex液相芯片方法检测3组患儿血清中的8种细胞因子,包括白细胞介素(IL)-2、IL-4、IL-6、IL-8、IL-10、粒细胞/巨噬细胞集落刺激因子(GM-CSF)、肿瘤坏死因子-α(TNF-α)和干扰素-γ(IFN-γ)。结果重型组25例,危重型组9例。与对照组比较,重型组IL-2和IL-10明显升高(P0.05);除IL-8外,危重型组中的7种细胞因子与重型组和对照组比较,均显著升高(P0.005,P0.001);脑炎合并肺炎组(13例)与脑炎组(17例)比较,IL-6显著升高(P0.05);EV71阳性组(8例)与病原学未检出组(16例)比较,IL-2、IL-4、IL-6、IL-10、GM-CSF、IFN-γ和TNF-α明显升高(P0.05)。结论多种细胞因子参与了HFMD重症病例的发病和发展,产生严重的炎症和抗炎反应。EV71阳性病例具有更加明显的免疫反应。

Multiplex serum cytokine levels in patients with severe HFMD determined by Luminex suspension array

Objective To investigate the changes of eight cytokines in severe hand-foot-mouth disease(HFMD) patients and their immune function and clinical significance. Methods Thirty-four cases of children with severe HFMD were divided into two groups: severe case and critical severe case. And 16 age-matched healthy children were enrolled in this study. To detect eight cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, GM-CSF, TNF-α, and IFN-γ) simultaneously by Luminex multiplexed assays. Results The result showed that the levels of IL-2 and IL-10 in severe cases were higher than healthy control subjects, and the differences were significant (P < 0.05). Besides IL-8, other cytokines in critical severe cases were all higher than severe cases and healthy control subjects, and the differences were significant (P < 0.005,P < 0.001). Higher serum IL-6 was in severe HFMD encephalitis complicated with pneumonia than in simple encephalitis patients (P < 0.05). A significant elevation of serum IL-2, IL-4, IL-6, IL-10, GM-CSF, TNF-α, and IFN-γ levels were observed in EV71 positive cases than negative cases (P < 0.05), but no significant differences of IL-8 level between the two groups. Conclusion There are different degrees of many cytokines increase in children with severe HFMD progresses, indicating that patients experience severe inflammatory and anti-inflammatory reaction and a variety of cytokines involved in the pathogenesis of severe cases. Pathogen-positive cases show more pronounced immune response than negative cases.