手足口病患儿体内免疫球蛋白、补体、C反应蛋白及刺激分析CD80、CD86水平的临床意义及其与丙种球蛋白治疗疗效的关系(1)
摘 要：目的 探討手足口病患儿血清免疫球蛋白、C反应蛋白、补体C3、C4、刺激分子CD80、CD86水平的临床意义，及其与丙种球蛋白治疗疗效的关系。方法 观察对象为我院儿科2015年7月～11月收治的60例重症HFMD患儿及60例非重症HFMD患儿，同时收集30例正常儿童血清样本作为对照组。比较各组患者血清免疫球蛋白、CRP、补体C3、C4、刺激分子CD80、CD86水平的差异与患儿病情严重程度之间的关系。另将重症HFMD患儿分为A、B两个亚组，A组进行常规营养支持对症治疗，B组在A组的治疗基础上联用人丙种免疫球蛋白治疗，比较A、B两组患儿病情的进展情况及与各指标之间的关系。结果 治疗前，重症HFMD患儿血清IgA、IgM、IgG及补体C3、C4显著低于普通组及对照组，差异有统计学意义(P<0.05)，同时普通组IgA、IgM、IgG及补体C3显著低于对照组，差异有统计学意义(P<0.05)，普通组补体C4与对照组差异无统计学意义(P>0.05)；重症HFMD患儿血清CRP水平明显高于普通组及对照组，差异有统计学意义(P<0.05)。重症组患儿外周血CD80/CD86显著高于普通组及对照组，差异有统计学意义(P<0.05)，普通组CD80/CD86显著高于对照组，差异有统计学意义(P<0.05)。治疗前，A、B组患儿各指标无统计学差异(P>0.05)。治疗后，A、B两组各指标相比治疗前均有显著性差异，差异有统计学意义(P<0.05)。A、B两组补体C3、C4水平未出现显著差异，差异无统计学意义(P>0.05)，A组CRP水平显著高于B组，差异有统计学意义(P<0.05)。A组外周血CD80/CD86显著高于B组，差异有统计学意义(P<0.05)。结论 HFMD患儿血清免疫球蛋白、补体C3及C4水平比相比正常人群显著下调，且随着病情的加重而降低；CRP及CD80/CD86相比正常人群显著上调，且随着病情的加重而升高，提示这些指标与患儿病情进展密切相关。联合应用丙种球蛋白治疗能够在对症支持治疗的基础上加快患儿康复进程。
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关键词：手足口病；免疫球蛋白；补体；C反应蛋白；CD80/CD86；丙种球蛋白
中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.02.022
文章编号：1006-1959(2018)02-0063-05
Abstract：Objective To investigate the clinical significance of serum immunoglobulin，C-reactive protein，complement C3 and C4，stimulatory molecules CD80 and CD86 in children with hand-foot-mouth disease and its relationship with the therapeutic effect of gamma globulin.Methods The subjects were 60 children with severe HFMD and 60 children with non-severe HFMD admitted to our pediatric department from July 2015 to November 2015.Thirty normal children's serum samples were collected as control group.The relationship between serum immunoglobulin，CRP， complement C3 and C4，CD80 and CD86 levels in patients and the severity of illness in children were compared.Another severe HFMD children were divided into A，B two subgroups，Group A was treated with conventional nutritional support symptomatic treatment.Group B was treated with Group A immunoglobulin on the basis of group A treatment.The progress of the disease in group A and group B was compared with that of each index.Results Before treatment，serum IgA，IgM，IgG and complement C3，C4 in children with severe HFMD were significantly lower than those in normal group and control group，The difference was statistically significant(P<0.05).At the same time，the levels of IgA，IgM，IgG and complement C3 in common group were significantly lower than those in control group，The difference was statistically significant(P<0.05)，the normal group of complement C4 and the control group was no significant difference(P>0.05)；severe HFMD serum CRP levels were significantly higher than the normal group and the control group，the difference was statistically significant(P<0.05).The levels of CD80/CD86 in peripheral blood of children with severe disease were significantly higher than those of control group and normal group(P<0.05)，The common group of CD80/CD86 was significantly higher than the control group，the difference was statistically significant(P<0.05).Before treatment，there was no significant difference in each index between A and B groups (P>0.05).After treatment，the indexes of A and B groups showed significant difference compared with before treatment，the difference was statistically significant(P<0.05).A，B two groups of complement C3，C4 levels were not significantly different，the difference was not statistically significant(P>0.05)，the CRP level of A group was significantly higher than that of B group，the difference was statistically significant(P<0.05).A group of peripheral blood CD80/CD86 was significantly higher than the B group，the difference was statistically significant(P<0.05).Conclusion Serum immunoglobulin，complement C3 and C4 levels in children with HFMD were significantly lower than those in the normal population，and decreased with the progression of the disease；CRP and CD80/CD86 were significantly up-regulated compared with the normal population，and with the progression of the disease high，suggesting that these indicators are closely related with the progress of children's condition.The combination of gamma globulin therapy can speed up the rehabilitation process in children based on symptomatic and supportive treatment., 百拇医药(覃艺 邓燕艺 赖昌生)
, http://www.100md.com
关键词：手足口病；免疫球蛋白；补体；C反应蛋白；CD80/CD86；丙种球蛋白
中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.02.022
文章编号：1006-1959(2018)02-0063-05
Abstract：Objective To investigate the clinical significance of serum immunoglobulin，C-reactive protein，complement C3 and C4，stimulatory molecules CD80 and CD86 in children with hand-foot-mouth disease and its relationship with the therapeutic effect of gamma globulin.Methods The subjects were 60 children with severe HFMD and 60 children with non-severe HFMD admitted to our pediatric department from July 2015 to November 2015.Thirty normal children's serum samples were collected as control group.The relationship between serum immunoglobulin，CRP， complement C3 and C4，CD80 and CD86 levels in patients and the severity of illness in children were compared.Another severe HFMD children were divided into A，B two subgroups，Group A was treated with conventional nutritional support symptomatic treatment.Group B was treated with Group A immunoglobulin on the basis of group A treatment.The progress of the disease in group A and group B was compared with that of each index.Results Before treatment，serum IgA，IgM，IgG and complement C3，C4 in children with severe HFMD were significantly lower than those in normal group and control group，The difference was statistically significant(P<0.05).At the same time，the levels of IgA，IgM，IgG and complement C3 in common group were significantly lower than those in control group，The difference was statistically significant(P<0.05)，the normal group of complement C4 and the control group was no significant difference(P>0.05)；severe HFMD serum CRP levels were significantly higher than the normal group and the control group，the difference was statistically significant(P<0.05).The levels of CD80/CD86 in peripheral blood of children with severe disease were significantly higher than those of control group and normal group(P<0.05)，The common group of CD80/CD86 was significantly higher than the control group，the difference was statistically significant(P<0.05).Before treatment，there was no significant difference in each index between A and B groups (P>0.05).After treatment，the indexes of A and B groups showed significant difference compared with before treatment，the difference was statistically significant(P<0.05).A，B two groups of complement C3，C4 levels were not significantly different，the difference was not statistically significant(P>0.05)，the CRP level of A group was significantly higher than that of B group，the difference was statistically significant(P<0.05).A group of peripheral blood CD80/CD86 was significantly higher than the B group，the difference was statistically significant(P<0.05).Conclusion Serum immunoglobulin，complement C3 and C4 levels in children with HFMD were significantly lower than those in the normal population，and decreased with the progression of the disease；CRP and CD80/CD86 were significantly up-regulated compared with the normal population，and with the progression of the disease high，suggesting that these indicators are closely related with the progress of children's condition.The combination of gamma globulin therapy can speed up the rehabilitation process in children based on symptomatic and supportive treatment., 百拇医药(覃艺 邓燕艺 赖昌生)