可溶性白细胞介素-2受体检测在儿童EB病毒感染相关疾病中的应用价值

目的探讨可溶性白细胞介素(白介素)-2受体检测在儿童EB病毒(EBV)感染相关疾病鉴别诊断中的应用价值。方法将72例患儿分为IM组、IM转化EBV相关的噬血细胞淋巴组织细胞增生症(EBV-HLH)组和EBV-HLH组;采用酶联免疫吸附试验(ELISA)分别检测患儿血清可溶性白介素-2受体和EBV抗体四项(EBV壳抗原VCA-IgM、VCA-IgG和EBV早期抗原EA-IgG、EBV核抗原-1 EBNA-1-IgG),荧光实时定量PCR检测患儿血浆EBV-DNA的表达,流式细胞术分析淋巴细胞亚群(CD3,CD4,CD8,CD19,CD56)。结果 72例患儿急性期可溶性白介素-2受体水平均超过2 400 U/ml;IM转化组在急性期可溶性白介素-2受体水平仅轻度增高(4 320 U/ml),与IM组(3 310 U/ml)无明显差异,治疗后却明显增高(8 970 U/ml),并接近EBV-HLH组水平(11 230U/ml);EBV抗体四项显示IM转化组和EBV-HLH组在治疗后VCA-IgG和EA-IgG仍然持续高滴度,同时EBV核抗原-1-IgG仍持续阴性;三组急性期都有EBV-DNA拷贝数从低拷贝至高拷贝的病例,治疗后IM转化组和EBV-HLH组仍可检测到EBV-DNA(3×103~4×105copies/ml);IM转化组和EBV-HLH组CD8+细胞在治疗后仍持续较高水平(61.32±4.63)%,(68.36±4.32)%],并同时出现NK细胞(CD56+)比例下降(9.23±3.28)%,(10.52.±3.34)%]。结论结合EBV抗体、EBV-DNA和淋巴细胞亚群检测,可溶性白介素-2受体检查有可能成为追踪观察EBV感染相关疾病的指标之一。

Significance of soluble IL-2 receptor detection in Epstein-Barr virus-associated disorders in children

Objective To study the application of soluble IL-2 receptor detection in Epstein-Barr virus-associated disorders in children.Methods Patients were divided into three groups: infectious mononucleosis group(IM group);infectious mononucleosis transform group(IMT group) and hemophagocytic lymphohistiocytosis group(HLH group).ELISA was used to detect the serum levels of soluble IL-2 receptor(sIL-2R) and four antibodies to EBV(viral capsid antigen VCA-IgM、viral capsid antigen VCA-IgG、Epstein-Barr virus early antigen EBV EA-IgG and Epstein-Barr virus nucleus antigen EBNA-1 IgG).EBV-DNA was measured by real time PCR,Moreover,the lymphocyte subpopulations(CD3,CD4,CD8,CD19,CD56) were analyzed by flow cytometry.Results The sIL-2R level was above 2 400 U/ml in all groups at acute phase,and was slight elevated in IMP group(4 320 U/ml) compared to IM group(3 310 U/ml),but was dramatically increased after therapy(8 970 U/ml),which almost approached the level of HLH group(11 230 U/ml).IMT and HLH groups kept high titer of VCA-IgG and EA-IgG but negative EBNA-1 IgG after therapy;EBV-DNA copy numbers were from low to high in all groups at acute phase and were still detected in IMT and HLH group after therapy(3×103 s/ml~4×105 copies/ml).CD8+ cells kept higher percentage (61.32±4.63)%,(68.36±4.32)%],with lower NK cells (CD56+ 9.23±3.28)%,(10.52.±3.34)%]in IMT and HLH groups after therapy.Conclusion Combined with EBV-antibodies,EBV-DNA and lymphocyte subpopulations analysis,soluble IL-2 receptor monitoring would be an effective index for following up EBV-associated disorders.