支原体肺炎患儿自身免疫功能检测及分析.doc

支原体肺炎患儿自身免疫功能检测及分析 　【摘要】 目的 观察支原体肺炎患儿自身免疫功能的变化。方法 将278例肺炎患儿分为支原体肺炎组135例、细菌性肺炎组143例，选取同期门诊体检正常小儿124例作为正常对照组，分别检测三组儿童的T细胞亚群、免疫球蛋白、补体C3、抗核抗体和循环免疫复合物。结果 支原体肺炎组患儿细胞免疫功能处于低下状态，主要表现为CD4+T细胞及CD4+/CD8+比值降低，与正常对照组比较，差异有统计学意义(Plt;0.01);支原体肺炎组体液免疫功能明显异常，主要表现为IgM，IgA，IgE水平升高，C3，C4水平下降，血清免疫复合物、抗核抗体阳性比例较高，与细菌性肺炎组和正常对照组比较，差异有统计学意义(Plt;0.01)。结论 支原体肺炎患儿容易有多种自身免疫功能的紊乱，可能与其多系统损伤有关。 【关键词】 肺炎，支原体/诊断; 细胞/免疫学; 体液/免疫学; 儿童 　　【Abstract】 Objective To observe the changes of autoinmmunity functions in children with mycoplasma pneumonia.Methods The T cell subgroup,immunoglobulin,complement,antinuclear antibody and circulating immune complex were detected in 135 children with mycoplasma pneumonia,143 children with bacterial pneumonia and 124 normal children,respectively.Results The cellular immunity function was in a low state in children with mycoplasma pneumonia,mainly presented with a decreased percentage of CD4+ T lymphocyte and a decreased ratio of CD4+/CD8+ (Plt;0.01).The humoral immune function was disordered in children with mycoplasma pneumonia,mainly presented with an increased level of IgM,IgA and IgE,an decreased level of C3 and C4,as well as a higher positive percentage of ANA and CIC (Plt;0.01).Both of the differences had statistical significance.Conclusion There are multiple disorders of autoimmunity function in children with mycoplasma pneumonia,which might contribute to the multisystemic damage in children with mycoplasma pneumonia. 　　【Key words】 Mycoplasma pneumonia/diagnosis; Cellular/immunity; Humoral/immunity; Children 　　肺炎支原体肺炎是小儿常见呼吸道感染性疾病，其发病机制主要有呼吸道上皮吸附作用、肺炎支原体(Mycoplasma pneumoniae,MP)直接侵入和免疫学紊乱等学说，目前较倾向于免疫学紊乱学说。近年有研究证实支原体感染与体液免疫、细胞免疫均有关[1,2]，存在机体免疫逃逸、免疫调节、免疫抑制、免疫蓄积等多种免疫作用[3]。为此，笔者观察支原体肺炎患儿自身免疫功能的变化，现报道如下。 　　1 资料与方法 　　1.1 临床资料 将2007～2008年住院的肺炎患儿及门诊体检的正常小儿，分为支原体肺炎组、细菌性肺炎组和正常对照组。支原体肺炎组患儿135例，其中男62例，女73例;年龄11个月至12岁，平均5.73岁。支原体肺炎的诊断标准如下：(1)发热、持续剧烈咳嗽、X射线所见远较体征显著;(2)白细胞大多正常或稍增高;(3)青霉素或头孢类抗生素治疗无效;(4)MP特异性抗体(MPIgM)阳性[4,5]。细菌性肺炎组患儿143例，其中男69例，女74例;年龄10个月至11岁，平均5.48岁。细菌性肺炎的诊断标准如下