儿童急性呼吸窘迫综合征CD4+ T细胞亚群格局及其影响研究

目的研究儿童急性呼吸窘迫综合征（ARDS）患儿中CD4+ T细胞亚群格局的变化及其对ARDS的关系。方法选择61例ARDS患儿，分为轻度组（25例）、中度组（20例）和重度组（16名）。同时，选取同期61例健康儿童作为对照组，采用流式细胞仪检测ARDS患儿和对照组外周血中T细胞总量、调节性T细胞（Treg）、Th17、Th1和Th2占CD4+ T细胞的比例。并观察CD4+ T细胞亚群主要细胞因子γ干扰素（IFN-γ）、白细胞介素（IL）-4、IL-17A、IL-17F的变化情况。结果与对照组比较，ARDS患儿T细胞总量、Th1、Th2、Th17细胞数量、Treg细胞、Th17/Treg比例、IL-4、IFN-γ、IL-17A及IL-17F因子均有不同程度的升高（P＜0.05~P＜0.01）；Spearman相关分析发现，ARDS患儿外周血IL-4、Foxp3、IFN-γ、IL-17A及IL-17F水平与小儿危重病评分均呈负相关关系（P＜0.01）。结论CD4+ T细胞亚群格局变化和ARDS发病密切相关，CD4+ T细胞亚群格局变化促进了ARDS的发生发展，形成了一个相互作用的炎症网络。

Pattern and influence of CD4 + T cell subsets in children with acute respiratory distress syndrome

ObjectiveTo study the changes of CD4+ T cell subsets and its effects on acute respiratory distress syndrome(ARDS) in children with ARDS.MethodsSixty-one children with ARDS were divided into the mild group(25 cases), moderate group(20 cases) and severe group(16 cases).At the same time, 61 healthy children were set as the control group.Flow cytometry was used to detect the total amount of T cells, regulatory T cells(Treg), Th17, proportion of Th1 and Th2 in CD4+ T cells in the peripheral blood of ARDS patients and control group.The major cytokines interferon-γ(IFN-γ), interleucin(IL-4), IL-17A and IL-17F in CD4+ T cell subsets were observed.ResultsCompared with the control group, the total amount of T cells, number of Th1, Th2, and Th17 cells and Treg cells, Th17/Treg ratio, and levels of IL-4, IFN-γ, IL-17A and IL-17F increased in ARDS children(P < 0.05 to P < 0.01).The results of Spearman correlation analysis showed that the levels of IL-4, Foxp3, IFN-γ, IL-17A and IL-17F were negatively correlated with prediatric critical illness scores in children with ARDS(P < 0.01).ConclusionsThe pattern of CD4+ T cell subsets is closely related to the pathogenesis of ARDS.The change of CD4+ T cell subsets promotes the development of ARDS, and forms an interactive inflammatory network.