感染性肺炎新生儿免疫功能系统评价及临床意义

目的探讨感染性新生儿肺炎免疫功能变化及其临床意义。 方法选取2016年3月至2017年10月深圳市龙华区中心医院新生儿科收治的感染性新生儿肺炎60例为观察组，同期选取健康新生儿60例为对照组。根据肺炎严重程度将观察组分为两个亚组：轻症组（39例）和重症组（21例）；根据新生儿感染性肺炎分期差异分为两个亚组：急性期组（24例）和恢复期组（36例）。入组患儿均于急性期、恢复期采集血样，用于体液免疫指标（免疫球蛋白IgA、IgM、IgG1、IgG2、IgG3、IgG4及补体C3、C4水平）和细胞免疫指标（CD3⁺ T、CD4⁺ T、CD8⁺ T、CD4/CD8、NK细胞）检测。 结果重症组患儿血清IgA、IgG1、IgG2、IgG3、IgG4水平、CD3⁺ T细胞、CD4⁺ T细胞、NK细胞比例及CD4/CD8较对照组和轻症组患儿均显著降低（P均< 0.05），IgM、C3、C4水平、CD8⁺ T细胞比例较对照组和轻症组患儿均显著升高（P均< 0.05），差异均有统计学意义。Spearman相关分析发现，血清IgA、IgG1、IgG2、IgG3、IgG4水平、CD3⁺ T细胞、CD4⁺ T细胞、NK细胞比例及CD4/CD8与新生儿感染性肺炎严重程度呈负相关（r =－0.826、－0.826、－0.665、－0.822、－0.826、－0.816、－0.794、－0.824、－0.820，P均< 0.001）；血清C3水平、CD8⁺ T细胞比例与新生儿感染性肺炎严重程度呈正相关（r = 0.467、0.788，P均< 0.001）。急性期患儿血清IgA、IgG1、IgG2、IgG3、IgG4水平、CD3⁺ T细胞、CD4⁺ T细胞、NK细胞比例及CD4/CD8均较恢复期和对照组显著降低（P均< 0.05），而血清IgM、C3、C4水平、CD8⁺ T细胞均较恢复期和对照组显著升高，差异均有统计学意义（P均< 0.05）。 结论感染性新生儿肺炎细胞免疫和体液免疫功能下降，与疾病严重程度呈负相关，且疾病不同阶段对免疫功能影响较大，应对该类患儿免疫功能加强调控。

Systematic review and clinical significance of immune function in neonates with infectious pneumonia

ObjectiveTo investigate the changes and clinical significance of immune function of neonates with infectious pneumonia. MethodsTotal of 60 neonates with infectious pneumonia admitted in the Department of Neonatology, the Central Hospital of Longhua District from March 2016 to October 2017 were selected as observation group, while 60 healthy newborns were selected as the control group during the same period. According to the severity of pneumonia, cases in observation group were divided into mild group (39 cases) and severe group (21 cases). According to the staging difference of neonatal infectious pneumonia, cases in observation group were divided into acute stage group (24 cases) and convalescent stage group (36 cases). The blood samples of all children were collected in acute period and recovery period, for the detection of humoral immunity indexes (IgA, IgM, IgG1, IgG2, IgG3, IgG4 and complement C3, C4) and cell immunity indexes (CD3⁺ T, CD4⁺ T, CD8⁺ T, CD4/CD8, NK cells). ResultsThe serum levels of IgA, IgG1, IgG2, IgG3, IgG4, the ratios of CD3⁺ T cells, CD4⁺ T cells, NK cell and CD4/CD8 in cases of severe group were significantly lower than those of the control group and mild group (all P < 0.05, but the ratios of IgM, C3, C4 and CD8⁺ T cells were significantly higher than those of the control group and mild group (all P < 0.05). Spearman correlation analysis showed that the levels of serum IgA, IgG1, IgG2, IgG3, IgG4, the ratios of CD3⁺ T cells, CD4⁺ T cells, NK cells and CD4/CD8 were negatively correlated with the severity of neonatal infectious pneumonia (r =-0.826, -0.826, -0.665, -0.822, -0.826, -0.816, -0.794, -0.824, -0.820; all P < 0.001). The level of serum C3 and CD8⁺ T cell ratio were positively correlated with the severity of neonatal infectious pneumonia (r = 0.467, 0.788; all P < 0.001). The levels of serum IgA, IgG1, IgG2, IgG3, IgG4, CD3⁺ T cells, CD4⁺ T cells, NK cells and CD4/CD8 of cases in the acute stage were significantly lower than those of the convalescent stage group and the control group (all P < 0.05), but the levels of serum IgM, C3, C4 and CD8⁺ T cells were significantly higher than those of the convalescent stage group and the control group, all with significant differences (all P < 0.05). ConclusionsCellular immunity and humoral immunity function of patients with neonatal infectious pneumonia declined, which were negatively correlated with the severity of disease. Diseases at different stages have great influence on immune status, which should be focused on the regulation of immune status of these neonates.