Th1／Th2／Th17 T／reg 对鉴别儿童支气管哮喘与单纯性肺炎的意义

目的：检测Th1（IFN-γ＋）、调节T细胞（CD2＋5Foxp3＋）、辅助T 细胞17（Th17）及细胞因子IL-2、IL -4、IL-17和IL-21在儿童支气管哮喘以及肺炎患儿外周血中的表达，探讨其在儿童支气管哮喘发病中的作用以及与肺炎鉴别的意义。方法收集哮喘患儿32例，肺炎患儿37例作为研究对象，选取同期体检的22例健康儿童为对照组。分离外周血单个核细胞，采用流式细胞术检测CD 4＋IFN-γ＋、CD 4＋CD 2＋5Foxp 3＋、CD4＋Th17＋细胞百分率。采用酶联免疫吸咐（ ELISA）法检测3组IL-2、IL-4、IL-17、IL-21表达水平。结果哮喘组患儿外周血CD4＋CD2＋5 Foxp3＋细胞占CD4＋T细胞的比率明显低于肺炎组及对照组；哮喘组患儿者外周血CD4＋IFN-γ＋细胞比例明显低于肺炎组和对照组；哮喘组患儿者外周血CD4＋Th17＋细胞所占比例高于肺炎组及对照组，差异均有统计学意义（ P ＜0*．05）。哮喘组患儿外周血IL-2的浓度明显低于对照组（ P ＜00．5），肺炎组患儿外周血IL-2浓度明显低于对照组（ P ＜0．05），但与哮喘组比较差异无统计学意义（ P ＞0．05）。哮喘组患儿外周血 IL4-、IL-17和IL-21的浓度明显低于肺炎组和对照组，差异有统计学意义（ P ＜0．05）。结论 Th1／T2h ／Th17／Treg功能失调参与了儿童支气管哮喘的发病机制，临床上可以通过检测Th1／Th2／Th17／Treg相关细胞因子的变化评估儿童支气管哮喘病情并辅助与肺炎的鉴别。

The is gn ificanc e of Thl/Th2/Thl7/Treg in distinguishing asthma for m pneum onia in children

Objective To investigate the levels of Th1 ( IFN-γ+) , regulatory T cells ( CD2+5 Foxp3 +) , helper T cells 17 (Th17), and cytokines-IL-2, IL-4, IL-17, IL-21 in peripheral blood of children with asthma and pneumonia,and to explore their significance in the pathogenesis of asthma and the differential diagnosis from pneumonia.Methods Thirty-two children with asthma ( asthma group ) and thirtys-even children with pneumonia ( pneumonia group ) were enrolled in the study,moreover, the other twenty-two healthy children were served as control group.The peripheral blood mononuclear cells ( PBMC) were separated, then the percentages of CD4+IFN-γ+,CD4+CD+25 Foxp3 +,CD4+Th17 +in PMBC were detected by flow cytometry.The expression levels of IL 2-,IL-4,IL-17 and IL-21 in plasma were detected by enzyme-linked mimunosorbent assay (ELISA).R esults The ratio(2.09 ±1.16)%] of CD4+CD2+5Foxp3 +cells/CD4+T cell in asthma group was obviously lower than that (5.13 ±2.41)%]in pneumonia group and that (5.67 ±2.79)%] in control group.The cell percentage of CD4+IFN-γ+in asthma group (8.47 ±3.23)%] was obviously lower than that in pneumonia group (15.48 ±3.00)%] and that in control group(14.84 ±3.74 )%].The percentage (7.40 ±2.69)%] of CD4+Th 17 +in asthma group was significantly higher than that (2.86 ±1.62)%] in pneumonia group and that (2.56 ±1.18)%] in control group (P <0.05).The levels of IL-2 in asthma group and pneumonia group were significantly lower than those in control group ( P <0.05).However there were no significant differences in the levels of IL-2 between asthma group and pneumonia group ( P >0.05).The concentrations of IL-4, IL-17 and IL-21 in asthma group were significantly lower than those in pneumonia group and those in control group ( P <0.05).Conclusion The functional disorder of Th1/T2h /Th17/Treg may be involved in the pathogenesis of asthma in children,which can be used as the indexes to evaluate pathogenetic condition of bronchial asthma in children and can distinguish it from pneumonia.