地塞米松对病毒性脑炎患儿CD4+、CD8+淋巴细胞水平的影响

目的观察地塞米松(DEX)对病毒性脑炎(病脑)患儿CD4 、CD8 淋巴细胞的影响。方法对82例轻中度病脑患儿应用DEX治疗,用流式细胞仪动态测定其CD4 、CD8 细胞数变化。结果1.治疗前DEX治疗组和无DEX治疗组与正常儿童比较,CD4 淋巴细胞数减少,CD8 淋巴细胞数增加,有显著差异(F=14.3 P<0.05)。2.治疗1周两组与治疗前比较,CD4 淋巴细胞数进一步减少,CD8 淋巴细胞数进一步增加,这些变化DEX治疗组较无DEX治疗组更明显,有显著性差异(P均<0.05)。3.治疗后4周两组CD4 、CD8 、CD4 /CD8 比值均较治疗前和治疗后1周时恢复,但DEX治疗组仍未恢复到对照组水平,差别仍有显著意义(P均<0.05)。结论DEX治疗病脑可抑制CD4 细胞增生,使CD4 细胞数延迟恢复正常,从而促使继发感染的人数增多。对轻中度病脑患儿应用DEX弊大于利,应慎用。

Effects of Dexamethasone on Changes of CD4+ , CD8+ Lymphocyte in Children with Viral Encephalitis

Objective To observe the effects of dexamethasone (DEX) therapy on the clinical outcome and changes of lymphocyte subsets in children with mild and severe encephalitis.Methods Eighty-two children with mild and severe viral encephalitis were randomly divided into two groups: with DEX treatment (n=46) or without(n=36).The clinical efficacy was evaluated 3 weeks later, and the clinical manifestation were also observed. The changes of CD4~ ,CD8~ T lymphocyte percentage were determined by flow cytometry on admission and at 1 week,4 weeks after treatment.Another group of 20 cases was enrolled as control group.Results Compared with the control group,both the DEX treatment group and non-DEX treatment group showed a reduced CD4~ lymphocyte count, an increased CD8~ lymphocyte count(P<0.05),but there was no significant difference between two groups(P<0.05).At 1 week After treatment the DEX treatment group showed much lower CD4~ lymphocyte count,and a higher CD8~ lymphocyte count than the non-DEX-treatment group. At 4 weeks after treatment,the DEX treatment group showed increased CD4~ lymphocyte count and a decreased CD8~ lymphocyte count when compared to those at 1 week after treatment.Non-DXE treatment group showed increased CD4~ lymphocyte count and a decreased CD8~ lymphocyte count when compared with those at 1 week after treatment.And there were no significant differences from those of the control group.Conclusion DEX therapy can improve the clinical manifestation in children with mild and severe viral encephalitis,but it can inhibit cellular immunity.