不同致敏模式支气管哮喘患儿外周血T淋巴细胞亚群比较及临床意义

目的：分析比较不同过敏原致敏模式下支气管哮喘患儿外周血T淋巴细胞亚群，为进一步明确不同变应原致敏哮喘患儿机体的免疫功能状态差异提供更多依据。方法：入组374例在北京儿童医院过敏反应科确诊的哮喘患儿，行过敏原皮肤点刺试验确定患儿致敏模式，流式细胞术测定外周血T细胞（CD3⁺CD19⁺）、CD4⁺T细胞（CD3⁺CD4⁺）、CD8⁺T细胞（CD3⁺CD8⁺）、Tregs（CD4⁺CD25⁺FOXP3⁺）、Th1（CD4⁺IFN-γ⁺T）、Th2（CD4⁺IL-4⁺T）以及Th17细胞亚群（CD4⁺IL-17A⁺T），横断面比较上述免疫学指标在不同致敏模式哮喘患儿组间是否存在差异。结果：根据SPT检出阳性过敏原数量，将哮喘患儿分为未致敏哮喘组、单一致敏哮喘组及多重致敏哮喘三组。与健康对照组儿童相比，未致敏哮喘组、单一致敏哮喘组以及多重致敏哮喘三组哮喘患儿的外周血T细胞、CD4⁺T细胞、CD8⁺T细胞、CD4/CD8比值、Th1细胞、Th2细胞、Th1/Th2比值、Tregs、Th17细胞、Tregs/Th17比值等指标的组间差异均具有统计学意义。进一步对三组患儿进行两两比较发现，Tregs、Th17细胞以及Tregs/Th17比值在三组间差异具有统计学意义（均P<0.05）。根据SPT阳性检出过敏原种类，将入组哮喘患儿致敏谱主要分为尘螨组、霉菌组、动物皮屑组、花粉组及其他组。与健康对照组儿童相比，尘螨组、霉菌组、动物皮屑组、花粉组以及其他组过敏原致敏患儿的外周血T细胞、CD4⁺T细胞、CD8⁺T细胞、CD4/CD8比值、Th1细胞、Th2细胞、Th1/Th2比值、Tregs、Th17细胞、Tregs/Th17比值等指标的组间差异均具有统计学意义（均P<0.05）。同样地，行两两比较发现，五组患儿的外周血Th1细胞、Th2细胞、Th1/Th2比值、Tregs、Th17细胞以及Tregs/Th17比值在三组间差异具有统计学意义（均P<0.05）。结论：不同致敏模式的哮喘患儿外周血T淋巴细胞亚群分布状态存在差异，因此应注意不同致敏模式的哮喘患儿免疫应答状态差异。

An analysis of circulating T lymphocytes among asthmatic children with different sensitized patterns

Objective:To investigate the difference in circulating T lymphocyte subsets among asthmatic children with different sensitized patterns. Methods: A total of 374 asthmatic children were enrolled in present study,and the sensitized patters were identified using skin prick testing.The numbers of circulating T cells(CD3^+,CD19⁺),CD4⁺T cells(CD3⁺,CD4⁺),CD8⁺ T cells(CD3⁺CD8⁺),TregsCD4⁺CD25⁺FOXP3⁺）,Th1（CD4⁺IFN-γ⁺T）,Th2（CD4⁺IL-4⁺T）and Th17 cells(CD4⁺ IL-17⁺T)in peripheral blood were measured by flow cytometry.Results: According to positive skin responses detected by SPT,patients with asthma were divided into three groups:un-sensitized asthma group,mono-sensitive asthma group and poly-sensitized asthma group.Compared with healthy controls,there were significant variations in CD4⁺ T cells and CD8⁺ T cells and CD4/CD8 ratio,Th1 cells and Th2 cells and Th1/Th2 ratio,Tregs,Th17 cells,Tregs/Th17 ratio(all P<0.05).A further pairwise comparison indicated that the statistically significant difference in Tregs,Th17 cells and Tregs/Th17 were found among un-sensitized asthma group,mono-sensitive asthma group and poly-sensitized asthma group(all P<0.05).According to the type of allergens detected by SPT,the asthmatic patients were divided into the dust mite group,mould group,animal dander group,pollen group and other groups.Compared with healthy controls,there were significant variations in CD4⁺ T cells and CD8⁺ T cells and CD4/CD8 ratio,Th1 cells and Th2 cells and Th1/Th2 ratio,Tregs,Th17 cells,Tregs/Th17 ratio(all P<0.05).Similarly,a pairwise comparison indicated that the numbers of Th1 cells,Th2 cells,Th2 cells,Th1/Th2 ratios,Tregs,Th17 cells and Tregs/Th17 ratios were found significant among these 5 groups(all P<0.05).Conclusion: The finding highlights the importance of paying attention to the differences in the distribution of T lymphocyte subgroups among asthmatic patients with different sensitization patterns.