手足口病患儿外周血CXC趋化因子配体10表达、T细胞及细胞因子与预后的相关性

目的检测手足口病（HFMD）患儿外周血中的CXC趋化因子配体10（CXCL-10）表达水平、T淋巴细胞亚群及相关细胞因子与HFMD患儿预后的相关性。 方法选取2016年4月至2017年5月徐州市儿童医院收治的HFMD患儿60例为研究对象，根据病情诊断标准分为重症组（10例）和轻症组（50例）；根据随访结果又分为预后良好组（58例）和预后不良组（2例）。选择同期体检正常婴幼儿52例为对照组。采用ELISA法检测两组研究对象外周血CXCL-10表达水平；采用流式细胞仪检测外周血T淋巴细胞亚群，采用ELISA法检测外周血中白细胞介素-17（IL-17）、IL-22、IL-23以及肿瘤坏死因子-α（TNF-α）水平。 结果重症组患儿外周血CXCL10水平、IL-17、IL-22、IL-23和TNF-α水平显著高于对照组和轻症组患儿（P均< 0.001）。轻症组患者细胞因子CXCL-10、IL-17、IL-22、IL-23和TNF-α水平高于对照组（P均< 0.005）。重症组HFMD患儿外周血CD3⁺ T、CD4⁺ T、CD8⁺ T以及CD4⁺/CD8⁺淋巴细胞比例显著低于轻症组患儿和对照组（P均< 0.05）；轻症组患儿外周血CD3⁺ T、CD4⁺ T、CD8⁺ T、CD4⁺/CD8⁺淋巴细胞比例与对照组差异有统计学意义（P均< 0.05）；经Pearson相关系数分析，HFMD患儿外周血CXCL-10表达水平与T淋巴细胞亚群CD3⁺T、CD4⁺ T、CD8⁺ T、CD4⁺/CD8⁺表达水平均负相关（r =－0.609、－0.714、－0.514、－0.524，P = 0.014、0.023、0.001、0.006），HFMD患儿外周血中IL-17、IL-22、IL-23和TNF-α水平与外周血CXCL-10水平正相关（r = 0.519、0.473、0.418、0.459，P = 0.002、0.006、0.009、0.007）；预后不良组患儿外周血CXCL-10表达水平显著高于预后良好组（t = 2.055、P = 0.044），外周血CD3⁺ T、CD4⁺ T、CD8⁺ T淋巴细胞比例显著低于预后良好组，差异均有统计学意义（t = 2.508、P = 0.015，t = 3.830、P < 0.001，t = 2.222、P = 0.030）。 结论手足口病患者外周血CXCL-10、T淋巴细胞亚群检测对病情监测及判断预后有重要价值。

Expression of chemokine ligand-10, T cells in peripheral blood of children with hand,foot and mouth disease and their correlation with prognosis

ObjectiveTo investigate the expression of chemokine ligand-10 (CXCL-10) in peripheral blood of children with hand, foot and mouth disease (HFMD), and the correlation between T lymphocyte subsets and related cytokines and prognosis in children with HFMD. MethodsFrom April 2016 to May 2017, a total of 60 children with HFMD were divided into severe group (10 cases) and mild group (50 cases) according to the diagnosis criteria, and were divided into good prognosis group (58 cases) and poor prognosis group (2 cases) according to the results of follow-up. While 52 infants with normal physical examination were selected as control group. The expression level of CXCL-10 in the peripheral blood of the two groups was detected by ELISA, the T-lymphocyte subpopulation of peripheral blood was detected by flow cytometry, and the levels of IL-17, IL-22, IL-23 and TNF-α in peripheral blood were detected by ELISA, respectively. ResultsThe levels of CXCL-10, IL-17, IL-22, IL-23 and TNF-α in peripheral blood of children in severe group were significantly higher than those of control group and mild group (all P < 0.001). The levels of CXCL-10, IL-17, IL-22, IL-23 and TNF-α of children in mild group were higher than those in control group (all P < 0.005). CD3⁺ T, CD4⁺ T and CD8⁺ T lymphocytes in peripheral blood of children in severe group were significantly lower than those of mild group and control group (all P < 0 05). There was significant difference in the proportion of CD3⁺ T, CD4⁺ T, CD8⁺ T and CD4⁺/CD8⁺ lymphocytes between children in mild group and control group (all P < 0.05). Pearson correlation coefficient analysis showed that the expression of CXCL-10 in peripheral blood of children with HFMD were negatively correlated with the expression of CD3⁺, CD4⁺, CD8⁺ T and CD4⁺/CD8⁺ (r =-0.609, -0.714, -0.514, -0.524; P = 0.014, 0.023, 0.001, 0.006). The levels of IL-17, IL-22, IL-23 and TNF-α in peripheral blood of children with HFMD were positively correlated with the levels of CXCL-10 (r = 0.519, 0.0.473, 0.418, 0.459; P = 0.002, 0.006, 0.009, 0.007). The expression of CXCL-10 in peripheral blood of children with poor prognosis was significantly higher than that of children with good prognosis (t = 2.055, P = 0.044). The proportion of CD3⁺ T, CD4⁺ T and CD8⁺ T lymphocytes in peripheral blood of children with poor prognosis were significantly lower than those of children with good prognosis, with significant differences (t = 2.508, P = 0.015; t = 3.830, P < 0.0001; t = 2.222, P = 0.030). ConclusionsThe detection of peripheral blood CXCL-10 and T-lymphocyte subsets in children with HFMD is of great value to monitor and judge the prognosis.