新生儿缺氧缺血性脑病细胞免疫功能的变化及其临床意义

目的：观察新生儿缺氧缺血性脑病(H IE)患儿外周血T细胞亚群和膜白介素-2受体(m IL-2R),血清IL-1,βIL-6,IL-10表达水平,探讨免疫学变化在H IE发病中的意义。方法：用生物素-链霉亲和素(BSA)系统检测新生儿H IE及足月正常新生儿生后第1,3,7天CD3+,CD4+,CD8+,CD4+/CD8+阳性百分率,及植物血凝素(PHA)诱导前后m IL-2R表达水平。用ELISA法动态检测新生儿及足月正常新生儿出生第1,3,7天血清IL-1β,IL-6,IL-10水平。结果：新生儿H IE患儿生后第1天CD3+,CD4+,CD8+分别为(37.4±6.7)%、(29.4±6.9)%、(16.7±3.3)%,CD4+/CD8+为1.8±0.5,静息期和诱导期m IL-2R表达水平分别为(3.6±1.1)%、(20.9±4.8)%,与正常组相比,差异有显著性(P<0.01~P<0.05)。生后第3天CD3+,CD4+,CD8+分别为(41.0±7.4)%,(35.8±6.9)%,(22.6±4.5)%,CD4+/CD8+为1.7±0.5,静息期m IL-2R表达水平(3.9±1.2)%,与正常组相比,差异有显著性(P<0.05)。生后第7天CD3+,CD4+,CD8+分别为(41.8±6.1)%、(36.4±5.1)%、(25.6±4.3)%,与正常组相比,差异有显著性(P<0.05)。CD4+/CD8+比值为1.5±0.3,诱导期m IL-2R表达水平(23.8±5.2)%,与正常组相比,差异无显著性(P>0.05)。H IE患儿血清IL-1,βIL-6,IL-10水平均显著高于正常组(P<0.05~P<0.01)。结论：H IE患儿存在一定程度的细胞免疫功能紊乱,与疾病的严重程度密切相关,其表达水平可作为H IE早期诊断、评价脑损伤程度及预后的参考指标。[中国当代儿科杂志,2005,7(6):499-502]

Detection of cellular immune function in neonates with hypoxic ischemic encephalopathy

OBJECTIVE: This study aimed to explore the relationship of the cellular immune function and the development of hypoxicischemic encephalopathy(HIE) by examining the levels of T subsets, membrane interleukin-2 receptor(mIL-2R), IL-1β, IL-6 and IL-10 in the peripheral blood of neonates with HIE. METHODS: The subjects included 32 term neonates with HIE and 30 healthy term neonates. The levels of CD3~+, CD4~+, and CD8~+, the ratio of CD4~+/CD8~+ and the mIL-2R levels before and after phytohemagglutinin (PHA) inducement were detected by biotin-streptavidin (BSA) on days 1, 3, and 7 after birth. Meanwhile, the levels of IL-1β, IL-6, and IL10 in serum were detected using ELISA. RESULTS: On the 1st day after birth,the levels of CD3~+, CD4~+ and CD8~+ and the ratio of CD4~+/CD8~+ in neonates with HIE were significantly lower than those in the normal controls. The mIL-2R levels before or after PHA inducement in HIE neonates were also significantly lower than those of the normal controls. On the 3rd day after birth, the levels of CD3~+, CD4~+ and CD8~+, and the ratio of CD4~+/CD8~+ in neonates with HIE remained lower than those in the normal controls. The mIL-2R level increased after PHA inducement in HIE neonates, but was still lower than that in normal controls. On the 7th day after birth, the levels of CD3~+, CD4~+ and CD8~+ in HIE neonates still remained lower than those in normal controls, but the ratio of CD4~+/CD8~+ and the mIL-2R level after PHA inducement were similar to those of the normal controls. The changes of T subsets and mIL-2R levels were most marked in neonates with severe HIE, followed by in those with moderate HIE. The serum levels of IL-1β,IL-6 and IL-10 in neonates with HIE increased significantly compared with those in normal controls on the days 1, 3, and 7 after birth. The increase was associated with the severity of HIE. CONCLUSIONS: Cellular immune function disturbance may exist in neonates with HIE. The expressive levels of cellular immune can be used as markers for early diagnosis of HIE and the evaluation of the severity of brain injury.