儿童支气管哮喘急性发作期免疫相关指标研究

目的 探讨儿童支气管哮喘急性发作期免疫球蛋白（immunoglobulin，Ig）G、IgM、B因子、补体C3及C4、T淋巴细胞亚群水平变化及与病情严重程度的相关性。方法 分析2020年1月至2022年7月诸暨市妇幼保健院儿科收治的133例支气管哮喘患儿的临床资料，根据患儿的情况分为急性期组（85例）和稳定期组（48例）；收集两组患儿入院时IgG、IgM、B因子、补体C3及C4、T淋巴细胞亚群（CD3+、CD4+、CD4+/CD8+）水平；分析急性期和稳定期上述指标的变化；比较不同急性发作期哮喘患儿上述指标的变化情况；采用Spearman线性方程分析Ig、补体及T淋巴细胞亚群水平与病情严重程度的相关性。结果 急性期组患儿的IgG、B因子、IgM、C3、C4水平低于稳定期组患儿，差异有统计学意义（P<0.05）；急性期组患儿的CD3+、CD4+、CD4+/CD8+水平低于稳定期组患儿，差异有统计学意义（P<0.05）；随着哮喘急性发作严重程度分级的提高，B因子、C3、C4及CD3+、CD4+、CD4+/CD8+水平逐渐降低，不同分级之间差异有统计学意义（P<0.05）；不同严重程度分级之间IgG水平比较，差异无统计学意义（P>0.05）；Spearman线性相关性分析显示，B因子、IgM、C3、C4、CD3+、CD4+、CD4+/CD8+水平与病情严重程度呈负相关（P<0.05）。结论 支气管哮喘急性发作期患儿机体存在明显的免疫功能紊乱，监测Ig、补体及T淋巴细胞亚群水平有助于评估疾病的严重程度。

Study on immune related indexes in children with bronchial asthma during acute attack

Objective To investigate the changes of the levels of immunoglobulin (Ig) G, IgM, factor B, complement C3 and C4, T lymphocyte subsets in children with bronchial asthma during acute attacks and their correlation with the severity of the disease. Methods The clinical data of 133 children with bronchial asthma admitted to the Department of Pediatrics, Zhuji Maternal and Child Health Hospital from January 2020 to July 2022 were analyzed. According to whether the children were in acute exacerbation stage, they were divided into acute stage group (85 cases) and stable stage group (48 cases); The data about the levels of IgG, IgM, factor B, complement C3 and C4, T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+) on admission were collected from the two groups of children; The acute phase and stable phase were analyzed. The changes of the above indicators, compared the changes of the above indicators in children with different acute attack; Spearman linear equation was used to analyze the correlation between Ig, complement, and T lymphocyte subsets levels and the severity of the disease. Results The level of IgG, factor B, IgM, C3 and C4 were lower than those in stable stage group, with statistical significance (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in acute stage group were lower than those in stable stage group, and the difference was statistically significant (P<0.05). With the improvement of the severity grade of acute asthma attack, the levels of factor B, C3, C4, CD3+, CD4+ and CD4+/CD8+ decreased gradually, and the differences among different grades were statistically significant (P<0.05). There was no significant difference in IgG level among different severity grades (P>0.05). Spearman linear correlation analysis showed that the levels of factor B, IgM, C3, C4, CD3+, CD4+ and CD4+/CD8+ were negatively correlated with the severity of the disease (P<0.05). Conclusion There is obvious immune dysfunction in children with acute attack of bronchial asthma. Monitoring the levels of Ig, complement and T lymphocyte subsets is helpful to evaluate the severity of the disease.