重症感染患儿胸腺萎缩与免疫的关系及影响因素

目的探讨小儿重症感染时胸腺萎缩与免疫的关系及影响因素。方法回顾性分析尸体解剖证实76例重症感染患儿和48例非感染患儿胸腺重量、细胞免疫指标及抗生素和地塞米松使用情况。结果重症感染患儿胸腺重量明显减轻,体积缩小,与非感染患儿胸腺比较有显著性差异（P〈0.01）;使用较大剂量地塞米松超过7d者其胸腺重量较3d者明显减轻,有显著性差异（P〈0.05）;重症感染患儿E-花环形成率、淋巴细胞转化率和T细胞亚群CD3^＋、CD4^＋、CD8^＋及CD4^＋/CD8^＋表达均明显低于非感染患儿（Pa〈0.05）;感染患儿病程与其胸腺重量呈明显负相关（r=-0.638P〈0.01）。结论胸腺萎缩可能是感染、蛋白质和热卡供给不足及滥用糖皮质激素等共同作用结果,并导致免疫功能低下。动态监测重症感染患儿免疫指标对临床诊治有重要指导意义。

Relationship between Immunity and Thymic Atrophy in Children and Its Influence Factors

Objective To investigate the relationship between immunity and acute thymic atrophy in children with severe infection and its influence factors.Methods The reviewing analysis had been done on thymic atrophy of 76 children with severe infection and 48 children with non-infectious.The thymic weights,immune function,the wide use of antibiotics and the abuse of dexamethasone in 2 groups were observed.Results The thymic weights in infectious group were significantly lighter than those in non-infectious group(P<0.01).The thymic weights were significantly lighter in 7 d than in 3 d those in children infection with the use of high doses dexamethasones.E-rosette formation ratio,lymphocyte transformation ratio and levels of CD3 ,CD4 ,CD8 and CD4 /CD8 ratio in children with severe infection were significantly lower than those in non-infectious group,respectively(Pa<0.05).Pearson correlation analysis showed that there were negative correlation between the thymic weights and the course of children infectious diseases(r=-0.638 P<0.01).Conclusions Thymic atrophy are probably due to infection,a shortage of protein and caloricity and the abuse of glucocorticoids,and that can lead to immune function declining.Evaluating the immune targets in children with severe infection may help guide the clinical diagnosis and treatment.