手术干预对OSAHS儿童外周血T淋巴细胞亚群及NK细胞活性的影响

发布时间：2018-06-04 08:12

本文选题：儿童阻塞性睡眠呼吸暂停低通气综合征 + T淋巴细胞亚群　；参考：《宁夏医科大学》2011年硕士论文

【摘要】：目的研究OSAHS儿童手术干预前后外周血中T淋巴细胞亚群及NK细胞活性的变化,评估手术干预对OSAHS儿童免疫功能的影响。方法选取2010年3月—2010年6月经整夜多导睡眠监测仪(PSG)确诊的OSAHS儿童36例,分别采集术前24～48h、扁桃体、腺样体切除术术后3个月及随访6个月的外周血样本,并选取30例年龄、性别匹配的排除相关疾病的健康儿童作为对照组。采用流式细胞术检测外周血中CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK细胞活性的水平,同时记录OSAHS儿童术前、手术干预3个月和随访6个月时PSG中LSaO_2、AHI的监测结果。并分别与健康儿童相比较。结果(1)与健康儿童比较:①OSAHS儿童术前外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK细胞活性显著减低(P0.01),而外周血CD8~+的百分率显著升高(P0.01);②治疗3月后,外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK细胞活性比较差异具有统计学意义(P0.01),但与OSAHS儿童术前比较差异无统计学意义(P0.05);③随访6个月后,外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK细胞活性与健康儿童比较差异无统计学意义(P0.05);④OSAHS组术前PSG中LSaO_2显著减低(P0.05),而AHI显著升高(P0.01);⑤治疗3月后,夜间LSaO_2升高,而AHI减低,但与健康儿童比较差异具有统计学意义(P0.05)。⑥随访6个月后,夜间LSaO_2及AHI与健康儿童比较差异无统计学意义(P0.01)。(2)直线相关分析显示:OSAHS组术前、术后外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK细胞活性与LSaO_2、AHI的变化有一定线性关系。随着夜间LSaO_2百分数的升高,外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK细胞活性均升高,且CD8~+的百分率减低。同时随着AHI的降低,OSAHS儿童外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK细胞活性均升高,且外周血CD8~+的百分率减低。结论(1)OSAHS儿童可能存在细胞免疫功能的下降,经扁桃体、腺样体手术干预3个月后,仍处于细胞免疫功能下降状态,而OSAHS儿童术后6个月时免疫功能失衡能够完全逆转,说明手术可以改善患儿的免疫功能,手术的远期效果得到了肯定。(2) OSAHS儿童外周血中CD3~+、CD4~+、CD8~+细胞的百分率、CD4~+/CD8~+比值及NK细胞活性与LSaO_2及AHI等反映病情的指标存在相关性。提示LSaO_2与AHI可能是OSAHS儿童细胞免疫功能的影响因素。
[Abstract]:Objective to study the changes of T lymphocyte subsets and NK cell activity in peripheral blood of children with OSAHS before and after operation, and to evaluate the effect of operation intervention on immune function of children with OSAHS. Methods 36 children with OSAHS diagnosed by polysomnography from March 2010 to June 2010 were collected from peripheral blood samples of 24 hours before operation, tonsil, 3 months after adenoidectomy and 6 months after adenoidectomy, and 30 cases of age were selected. Sex matched healthy children excluded from related diseases as control group. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the activity of NK cells in peripheral blood were measured by flow cytometry. The monitoring results of LSaO2AHI in PSG before operation, 3 months after operation and 6 months follow up were recorded in children with OSAHS. And compared with healthy children. Results (1) compared with healthy children, the percentage of CD3 ~ + CD4 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood of children with 1 / 1 OSAHS were significantly lower than those of healthy children, while the percentage of CD8 ~ in peripheral blood increased significantly after 3 months of treatment. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ were significantly different in NK cell activity, but there was no significant difference between them before and after 6 months follow-up. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood were not significantly different from those in healthy children. The LSaO_2 in PSG of P0.05 + 4OSAHS group was significantly lower than that of healthy children before operation. However, AHI increased significantly after 3 months of treatment, LSaO_2 increased at night and AHI decreased after treatment. However, there was no significant difference in LSaO_2 and AHI between children and healthy children after 6 months follow-up. The linear correlation analysis showed that there was no significant difference in LSaO_2 and AHI between children and healthy children (P < 0.05). The linear correlation analysis showed that: before operation, there was no significant difference between the two groups. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood after operation were linearly correlated with the changes of LSaO _ 2AHI. With the increase of nocturnal LSaO_2 percentage, the percentage of CD3 ~ + CD4 ~ and the ratio of CD4 ~ / CD8 ~ in peripheral blood increased, and the percentage of CD8 ~ was decreased. At the same time, with the decrease of AHI, the percentage of CD3 ~ + CD4 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood of children with OSAHS increased, and the percentage of CD8 ~ in peripheral blood decreased. Conclusion there may be a decrease in cellular immune function in children with OSAHS. After 3 months of intervention through tonsils and adenoids, the cellular immune function of children with OSAHS is still in a state of decline, but the imbalance of immune function in children with OSAHS can be completely reversed at 6 months after operation. The long-term effect of the operation was confirmed. The percentage of CD3 ~ + CD4 ~ + CD8 ~ cells in peripheral blood of children with OSAHS and the ratio of CD4 ~ / CD8 ~ and NK cell activity were correlated with LSaO_2, AHI and so on. It is suggested that LSaO_2 and AHI may be the influencing factors of cellular immune function in children with OSAHS.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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