婴幼儿喘息性疾病血清IL-4、IFN-γ及尿LTE4浓度变化及意义研究

发布时间：2018-09-01 05:18

【摘要】：目的：通过检测婴幼儿喘息患儿、非喘息患儿不同时期及正常健康儿血清白介素-4（IL-4）、干扰素-γ（IFN-γ）及尿白三烯（LTE4）水平，探讨血清IL-4、IFN-γ及尿LTE4在婴幼儿喘息性疾病病情发展中的作用及相互关系；从而探讨婴幼儿喘息性疾病的可能发病机制，为临床治疗婴幼儿喘息性疾病提供一定的理论依据。方法：选择2011年1月至2011年12月在我院儿科门诊和住院的婴幼儿（年龄3岁）。采用竞争性酶联免疫吸附分析法（ELISA）检测22例急性期、恢复期因喘息性疾病就诊的患儿（喘息组），排除大气道梗阻、气道异物及心源所致喘息，20例急性期、恢复期非喘息的下呼吸道感染患儿（非喘息组），20例健康体检儿（正常对照组）血清IL-4、IFN-γ及尿LTE4水平。三组在年龄、性别上无显著性差异，入组前四周均未使用激素类药物及白三烯调节剂。收集喘息组、非喘息组急性发作期/恢复期及正常健康对照组儿童的血、尿标本。标本收集后均离心后冷冻保存，应用SPSS13.0软件就上述结果进行统计分析。结果： 1.各组血清IL-4水平的比较：喘息组急性期血清IL-4水平较非喘息组急性期及正常对照组均明显升高（P＜0.01），均有统计学意义；恢复期（临床缓解期）血清IL-4水平较急性期明显下降(P＜0.01)，与非喘息组恢复期比较差异无统计学意义（P＞0.05），但仍高于正常对照组(P＜0.01)，有统计学意义。 2.各组血清IFN-γ水平的比较：喘息组急性发作期血清IFN-γ水平较非喘息组急性期及正常对照组均明显降低(P＜0.01)，恢复期血清IFN-γ水平较急性期明显升高(P＜0.01)，但仍低于非喘息组恢复期和正常对照组(P＜0.01)，均有统计学意义。 3.各组血清IL-4/IFN-γ比值的比较：喘息组急性期血清IL-4/IFN-γ比值较非喘息组急性期及正常对照组均明显升高（F=15.86，P＜0.01）；恢复期血清IL-4/IFN-γ比值较急性期明显下降(t=4.14，P＜0.01)，但仍高于非喘息组恢复期及正常对照组，且有统计学差异(F=19.98，P＜0.01)。 4.各组尿LTE4水平的比较：喘息组急性期尿LTE4水平较正常对照组明显升高(P＜0.01)，有统计学意义，但与非喘息组急性期比较差异无统计学意义（P＞0.05）。恢复期尿LTE4水平较急性期明显降低(P＜0.01)，但仍高于非喘息组恢复期和正常对照组(P＜0.01)，有统计学意义。 5.血清IL-4、IFN-γ与尿LTE4水平相关性分析：喘息组急性期血清IL-4与尿LTE4呈正相关（r=0.823，，P＜0.01）；喘息组急性期血清IFN-γ与尿LTE4与呈负相关（r=-0.806，P＜0.01），均有统计学意义。结论： 1.婴幼儿喘息组急性发作期血清IL-4水平均高于非喘息组及正常对照组，且随着病情的缓解而下降，但缓解期仍高于非喘息组及正常对照组，提示IL-4参与了喘息性疾病的急性发作及慢性持续的炎症反应。 2.婴幼儿喘息组急性期血清IFN-γ水平低于非喘息组、正常对照组，病情缓解后血清IFN-γ水平升高，但仍低于非喘息组及正常对照组，提示IFN-γ亦参与了喘息的发作。 3.婴幼儿喘息组急性期血清IL-4/IFN-γ较非喘息组急性期及正常对照组均明显升高，且随着病情的缓解而下降，但缓解期仍高于非喘息组及正常对照组，提示喘息患儿早期即存在Th1/Th2免疫失衡，Th2占优势，为早期对喘息性疾病患儿给予干预提供理论依据。 4.婴幼儿喘息组急性期尿LTE4水平均高于非喘息组及正常对照组，且随着病情的缓解而下降，但缓解期仍高于非喘息组及正常对照组，提示CysLTs参与了喘息性疾病的急性发作及慢性持续的炎症反应。 5.喘息患儿急性发作期血清IL-4水平与尿LTE4水平有显著的正相关性，血清IFN-γ与尿LTE4水平呈显著的负相关，提示IL-4、IFN-γ与CysLTs可能共同参与了喘息性疾病的急性发作，且两者之间可能具有促进和抑制作用，从而加重喘息的发生与发展。 6.喘息患儿血清IL-4、尿LTE4水平持续升高、IFN-γ水平降低， Th1/Th2免疫失衡可能是导致婴幼儿喘息的重要原因之一，为临床施行免疫干预，调整Th1/Th2免疫失衡，使用白三烯受体拮抗剂治疗婴幼儿喘息性疾病提供了一定的理论依据。
[Abstract]:Objective:
To investigate the role of serum interleukin-4 (IL-4), interferon-gamma (IFN-gamma) and urinary leukotriene (LTE4) in the development of infantile wheezing diseases, and to explore the possible relationship between serum IL-4, IFN-gamma and urinary LTE4 in the development of infantile wheezing diseases. Pathogenesis provides a theoretical basis for clinical treatment of wheezing diseases in infants.
Method:
From January 2011 to December 2011, 22 infants (3 years old) with acute and convalescent asthmatic diseases (asthmatic group) were examined by competitive enzyme-linked immunosorbent assay (ELISA), excluding airway obstruction, asthma caused by airway foreign body and cardiac source, and 20 infants (non-asthmatic) in acute and convalescent period. Serum IL-4, IFN-gamma and urinary LTE4 levels were not significantly different among the three groups in age and sex. No hormone drugs or leukotriene modulators were used in the first four weeks of the study. Serum levels of IL-4, IFN-gamma and urinary LTE4 in the asthmatic group, the non-asthmatic group and the normal control group were collected. Blood and urine specimens were collected and frozen after centrifugation. The results were analyzed by SPSS 13.0 software.
Result:
1. Comparison of serum IL-4 levels in each group: The serum IL-4 levels in the acute stage of asthma group were significantly higher than those in the non-asthmatic group and the normal control group (P < 0.01), and the serum IL-4 levels in the convalescent stage (clinical remission stage) were significantly lower than those in the acute stage (P < 0.01), and there was no significant difference between the convalescent stage and the non-asthmatic group (P > 0.01). .05), but still higher than the normal control group (P < 0.01), with statistical significance.
2. Comparison of serum IFN-gamma levels in each group: The serum IFN-gamma levels in the asthmatic group were significantly lower than those in the non-asthmatic group in the acute phase and the normal control group (P < 0.01), and the serum IFN-gamma levels in the convalescent phase were significantly higher than those in the acute phase (P < 0.01), but still lower than those in the non-asthmatic group in the convalescent phase and the normal control group (P < 0.01).
3. Comparison of serum IL-4/IFN-gamma ratio in each group: The serum IL-4/IFN-gamma ratio in acute stage of asthma group was significantly higher than that in non-asthmatic group and normal control group (F = 15.86, P < 0.01); the serum IL-4/IFN-gamma ratio in convalescent stage was significantly lower than that in acute stage (t = 4.14, P < 0.01), but still higher than that in convalescent stage and normal control group. Academic differences (F=19.98, P < 0.01).
4. Comparison of urinary LTE4 levels in each group: Urinary LTE4 levels in the asthmatic group were significantly higher than those in the normal control group (P < 0.01), but there was no significant difference between the asthmatic group and the non-asthmatic group (P > 0.05). Group P (0.01) was statistically significant.
5. Correlation analysis of serum IL-4, IFN-gamma and urinary LTE4 levels: Serum IL-4 and urinary LTE4 were positively correlated in asthmatic group at acute stage (r = 0.823, P < 0.01); serum IFN-gamma and urinary LTE4 were negatively correlated in asthmatic group at acute stage (r =-0.806, P < 0.01).
Conclusion:
1. The serum levels of IL-4 in the asthmatic group were higher than those in the non-asthmatic group and the normal control group, and decreased with the remission of the disease, but the remission period was still higher than that in the non-asthmatic group and the normal control group, suggesting that IL-4 participated in the acute attack of asthmatic disease and chronic persistent inflammatory reaction.
2. The level of serum IFN-gamma in asthmatic infants was lower than that in non-asthmatic infants. In normal control group, the level of serum IFN-gamma increased after remission, but it was still lower than that in non-asthmatic infants and normal infants, suggesting that IFN-gamma also participated in the onset of asthma.
3. The serum levels of IL-4/IFN-gamma in the acute stage of wheezing infants were significantly higher than those in the non-wheezing infants and the normal control group, and decreased with the remission of the disease, but the remission period was still higher than that in the non-wheezing infants and the normal control group. Provide theoretical basis.
4. Urinary LTE4 levels in the asthmatic group were higher than those in the non-asthmatic group and the normal control group, and decreased with the remission of the disease, but the remission period was still higher than that in the non-asthmatic group and the normal control group, suggesting that CysLTs participated in the acute attack of asthmatic diseases and chronic persistent inflammatory reaction.
5. There was a significant positive correlation between serum IL-4 level and urinary LTE4 level in children with asthma at acute attack stage, and a significant negative correlation between serum IFN-gamma and urinary LTE4 level, suggesting that IL-4, IFN-gamma and CysLTs may participate in the acute attack of asthmatic diseases, and the relationship between them may promote and inhibit the occurrence and development of asthma.
6. The levels of serum IL-4, urinary LTE4 and IFN-gamma in children with wheezing were continuously elevated, and the imbalance of Th1/Th2 immunity may be one of the important causes of wheezing in infants. It provides a theoretical basis for clinical immune intervention, adjusting the imbalance of Th1/Th2 immunity, and using leukotriene receptor antagonists to treat wheezing diseases in infants.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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