天津医药

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RSV肺炎患儿TLR4及IFN-γ临床观察

朱秋皎   

  1. 苏州大学附属儿童医院
  • 收稿日期:2011-07-22 修回日期:2012-02-12 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 朱秋皎

The Research of Clinical Significance for Expression of TLR4 and IFN-γ In RSV Pneumonia Children

  • Received:2011-07-22 Revised:2012-02-12 Published:2012-07-15 Online:2012-07-15

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摘要： 【摘要】目的 观察呼吸道合胞病毒（RSV）肺炎患儿急性期外周血单核细胞表面Toll样受体4（TLR4）的表达以及急性期血清中IFN-γ水平的变化和病情严重程度、过敏状态的关系。方法 分组：1.实验组为RSV阳性的肺炎患儿30例；对患儿入院时的临床表现，将患儿分为轻度组和重度组，其中轻度组22例，重度组8例；根据患儿的过敏状况（如湿疹史）及家族过敏史（哮喘、过敏性鼻炎、过敏性结膜炎、特应性皮炎等）分为具有过敏因素组19例和无过敏因素组11例。2.对照组27例为年龄在2岁以内，同时期在医院外科住院，近一周内无呼吸道感染的患儿。结果 1.实验组TLR4为22.29±9.46%，对照组为12.67±9.46%，利用秩和检验检测存在显著性差异（P =0.001<0.05）。实验组中轻度组的TLR4为21.44±16.33%，重度组为24.61±17.28%，两组差异无显著性（P =0.872>0.05）；实验组中具有过敏因素组TLR4为21.99±16.14%，而无过敏因素组为22.76±17.48%，两组也无显著差异性（P =0.966>0.05）。2.实验组IFN-γ的浓度为254±504.48ng/L，对照组IFN-γ的浓度为259.89±829.91ng/L，经秩和检验发现无显著差异性（P =0.64>0.05）。实验组中轻度组IFN-γ为324.8±568.19ng/L，重度组为62.36±167.6ng/L，两组有显著的差异性（P =0.045<0.05）；而具有过敏因素组IFN-γ为350.19±586.57ng/L，无过敏因素组为90.09±267.56ng/L，两组无显著差异性（P =0.25>0.05）。结论 RSV肺炎感染早期外周血单核细胞表面TLR4表达升高；TLR4的表达与疾病的严重程度无明显的相关性；并且RSV感染早期血清中IFN-γ的浓度与正常婴幼儿无明显差异；IFN-γ的水平与疾病的严重程度呈现明显的负相关，重度患儿IFN-γ浓度显著低于轻度患儿，对重度的RSV肺炎患儿使用干扰素是合理的；RSV感染时IFN-γ的浓度与过敏因素之间未发现有显著的联系。

关键词: 呼吸道合胞病毒, Toll样受体4（TLR4）, IFN-γ

Abstract: 【Abstract】Object:First,to observe the expression of TLR4 on monocytes in peripheral blood after RSV infection and the relationship between TLR4 expression and disease severity or atopic disposition;Second,,to evaluate the relationgship between IFN-γ concentration and disease severity or atopic disposition in acute infection phase.Method:group 1:test group:30 children who got pneumonia,then the group was devided into two subgroup:22 children are the mild and moderate ones,8 children are severe ones.On the basis of atopy(eczema,for example)and family history(asthma,allergic rhinitis,allergic conjunctivitis,atopic dermatitis and so on)，we devide the group into two groups:one group with atopic disposition concludes 19 children and the other without atopic disposition concludes 11 children.Group 2:27 children admitted into hospital for surgical reasons without respiratory infection in the last week.Results:1.The expression of TLR4 in the test group is 22.29±9.46%,and in control group is 12.67±9.46%,there is statistical significance(P =0.001<0.05）by U test.TLR4 in mild and moderate group of test group is 21.44±16.33%,while in severe group is 24.61±17.28%,there is no statistical significance(P =0.872>0.05）.TLR4 in test group with atopic disposition is 21.99±16.14%,and in group without atopic disposition is 22.76±17.48%,there is no statistical significance(P =0.966>0.05).2.The concentration of IFN-γ in test group is 254±504.48ng/L,and in control group is 259.89±829.91ng/L,and between the two groups there is no statistical significance(P =0.64>0.05).The concentration in mild and moderate group of test group is 324.8±568.19ng/L,while in severe grouop is 62.36±167.6ng/L,obviousely there is statistical significance(P =0.045<0.05）.The concentration in test group with atopic disposition is 350.19±586.57ng/L,and in test group without atopic disposition is 90.09±267.56ng/L,and there is no statistical significance(P =0.25>0.05）.Conclusion:The expression of TLR4 on peripheral blood monocyte up-regulates during RSV infection.But it does not obviously relate to the severity of disease,and is not influced by atopic disposition during acute RSV infection.The concentration of IFN-γ in test group is not significantly different from that of control test.It negatively relates to disease severity,that the concentration of severe children is lower than that of mild children.It is rational to use IFN-γfor severe RSV pneumonia.During RSV infection ,the concentration of IFN-γ has not distinct relation with atopic disposition.

Key words: Respiratory Syncytial Virus, Toll-like Receptor 4, IFN-γ