摘要
目的探讨抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎患儿外周血T、B、NK淋巴细胞亚群的变化及其临床意义。方法选取2017年1月至2019年8月在广州市妇女儿童医疗中心神经内科首次诊断并住院治疗的40例抗NMDAR脑炎患儿为研究对象,同期健康体检儿童20例为对照组。病例组于治疗前、治疗1个月后分别行全血T、B、NK淋巴细胞绝对计数及百分比检测;治疗前血清免疫球蛋白G(immunoglobulin G,IgG)、IgA、IgM测定,病例组血和脑脊液抗NMDAR抗体滴度,比较病例组不同时间点及其与对照组之间的差异,并根据治疗2周的改善情况将病例组分为改善组和无效组,比较两组间治疗前T、B、NK淋巴细胞绝对计数的差异。结果与对照组相比,病例组患儿治疗前、后血B细胞绝对计数均显著升高,差异有统计学意义(P<0.05);病例组内B细胞绝对计数治疗前和治疗后比较差异无统计学意义(P>0.05);治疗后T细胞(包括T抑制细胞与T辅助细胞)较治疗前和对照组均显著升高,差异有统计学意义(P<0.05);病例组治疗前T细胞和对照组比较差异无统计学意义0.05);治疗前B细胞百分比较对照组和治疗后显著升高,差异有统计学意义(P<0.05)。病例组中治疗2周无效组具有更高的B、T细胞水平,与改善组比较差异有统计学意义(P<0.05);病例组IgG、IgA、IgM水平和对照组比较差异无统计学意义。治疗前病例组B细胞绝对计数与脑脊液抗NMDAR抗体水平无明显相关性(r=0.282,P>0.05)。结论抗NMDAR脑炎患儿血B细胞显著升高,治疗前B细胞的水平与治疗起效情况有关,T细胞在治疗后升高。脑脊液抗NMDAR抗体滴度与血B细胞水平无明显相关性。
Objective To investigate the variation of T, B, NK lymphocyte subgroup in children with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis and their clinical significance.Methods This was a prospective and control study.Forty children primarily diagnosed with anti-NMDAR encephalitis in the department of neurology in Guangzhou Women and Children′s Medical Center from January 2017 to August 2019 served as patient group, 20 healthy children served as control group.Absolute counts and percentages of T, B and NK lymphocytes in whole blood were detected before and 1 month after treatment in patient group.Serum immunoglobulin G(IgG), IgA and IgM were measured before treatment.The blood levels of T, B, NK lymphocyte subgroup were detected with flow cytometer.NMDAR antibody titers of serum and cerebrospinal fluid were detected in patient group.The differences between patient group at different time points and control group were compared.The patients were divided into two groups according to the response to treatment after 2 weeks and the absolute counts of T, B and NK lymphocytes before treatment were compared between groups.Results Compared with control group, the blood absolute count of B lymphocyte in patient group were significantly higher before and after treatment(P<0.05). There was no significant difference of B lymphocyte in patient group between before and after treatment.After treatment, T cells(including T inhibitory cells and T helper cells)were significantly increased compared with those before treatment and those in control group(P<0.05), but there was no significant difference between patient group and control group before treatment.These with poor response to treatment after 2 weeks had higher level of B, T lymphocyte subgroup compared to those with good response(P<0.05). The level of IgG, IgA, IgM in patient group showed no significant difference with control group.There was no significant correlation between B lymphocyte count in blood and NMDAR antibody titer in cerebrospinal fluid(r=0.282, P>0.05)
作者
田杨
廖寅婷
侯池
李小晶
曾意茹
陈文雄
朱海霞
Tian Yang;Liao Yinting;Hou Chi;Li Xiaojing;Zeng Yiru;Chen Wenxiong;Zhu Haixia(Department of Pediatric Neurology,Guangzhou Women and Children′s Medical Center,Guangzhou 510000,China)
出处
《国际儿科学杂志》
2020年第6期436-440,共5页
International Journal of Pediatrics
基金
广东省科学技术厅计划项目(2016ZC0229)。
