摘要
目的通过观察儿童重症化脓性脑膜炎早期血CD3＋CD8＋T细胞的变化，以及与炎症指标、体液免疫指标之间的关系，探讨其在儿童重症化脓性脑膜炎发生发展中的临床意义。方法回顾性分析中国医科大学附属盛京医院PICU2014年8月1日至2015年12月31日收治的39例1个月～14岁的重症化脓性脑膜炎患儿，血CD3＋CD8＋T细胞计数正常或升高（≥190个／mm3）为A组（n=22），降低（〈190个／mm3）为B组（n=17），分析患儿的一般资料、血液炎症指标、体液免疫、脑脊液改变在两组患儿中的分布和差异。结果17例（43．6％）患儿CD3＋CD8＋T细胞明显下降；所有4例死亡均为B组患儿；虽然没有统计学差异，但B组Glasgow昏迷评分〈8分者比例（58．8％）高于A组（31．8％）。B组C-反应蛋白、降钙素原中位数（最小值-最大值）分别为251．0（26．2-417．0）mg／L、32．7（0．9-100．0）ng／L，远远高于A组的106．5（12．0-458．0）mg／L、4．5（0．1—200．0）ng／L，差异有统计学意义（P〈0．05）；B组中6例（35．3％）外周血WBC〈4×10^9／L，而A组为1例（4．6％），中性粒细胞〉80％的比例A组为7例（31．8％），而B组为12例（70．6％），两组比较差异有统计学意义（P〈0．05）。B组14例（82．3％）患儿脑脊液中糖含量〈2．0mmol／L，高于A组[11例（50．0％）]，两组比较差异有统计学意义（P〈0．05）。结论儿童重症化脓性脑膜炎CD3＋CD8＋T细胞可能受到抑制，其与患儿脑功能损伤程度、炎症反应以及预后相关。可能对指导临床免疫制剂的应用有一定帮助。
Objective To explore the role of CD3＋ CD8＋T cells in children with severe bacterial meningitis at early stage by studying the changes of CD3 ＋ CD8 ＋ T cells and its relationships with markers of inflammation and humoral immunity. Methods Thirty-nine cases aged ≤ 14 years old were enrolled in this retrospective study, who were admitted in our PICU from Aug 1. 2014 to Dec 31. 2015 with diagnosis of severe bacterial meningitis. The patients were divided into 2 groups according to the changes of CD3＋ CD8＋ T cells ： group A： normal or elevated （ ≥ 190/mm3 , n = 22 ）, group B ： decreased （ 〈 190/mm3 , n = 17 ）. Distribution and differences of biomarkers of inflammation, humoral immunity and changes in cerebrospinal fluid between the two groups were analyzed. Results The ratio of CD3＋ CD8 ＋ T cells were decreased in 17 （43.6%） cases. Though there was no statisticly significant difference, the percentile of patients in group B （58.8%） with Glasgow coma score lower than 8 was higher than that in group A（31.8% ）. All the four death were in group B. The mean values of C-reactive protein and procalcitonin were 251.0 （26. 2,417.0） mg/L,32. 7 （0. 9,100. 0） ng/L in group B, which were higher than those in group A E 106. 5 （ 12. 0,458.0 ） rag/L,4. 5 （0. 1,200. 0） ng/L] ,respectively（P 〈 0. 05）. Six cases（35.3% ） in group B with WBC 〈 4 × 10^9/L was more than 1 case（4. 6% ） in group A,and 12 cases（70. 6% ） in group B with ratio of neutrophils 〉 80% was more than 7 cases（31.8% ） in group A, there were significant differences （P 〈 0. 05 ）. Fourteen cases（82. 3% ） with glucose concentration lower than 2. 0 mmol/L in group B was more than 11 cases （50. 0% ） in group A, the difference was significant （ P 〈 0. 05 ）. Conclusion CD3＋ CD8 ＋ T cells might be suppressed in children with severe bacterial meningitis at early stage, and might associate to the damaging degree of brain, inflammation reaction and prognosis in those p
作者
许巍
尹苗
王丽杰
赵莹
裴亮
刘春峰
Xu Wei Yin Miao Wang Lijie Zhao Ying Pei Liang Liu Chunfeng.(Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China)
出处
《中国小儿急救医学》
CAS
2017年第1期39-43,共5页
Chinese Pediatric Emergency Medicine
