儿童社区获得性肺炎血清维生素A的变化及与免疫功能相关性

doi:10.3969/j.issn.1004-583X.2022.07.007

摘要/Abstract

摘要：

目的研究社区获得性肺炎(community acquired pneumonia,CAP)患儿血清维生素A(vitamin A,VA)水平及与免疫功能的相关性,为肺炎病情评估提供一定参考。方法以入住新乡医学院第一附属医院PICU的63例重度社区获得性肺炎(severe community acquired pneumonia, SCAP)患儿(SCAP组)、普通儿科病区的30例轻度社区获得性肺炎(mild community acquired pneumonia, MCAP)患儿(MCAP组),以及同期体检的30名健康儿童(对照组)为研究对象,检测其血清中VA和免疫球蛋白(immunoglobulin,Ig)G、IgA、IgM水平,及SCAP组体内T淋巴细胞亚群(总T淋巴细胞、CD4、CD8、CD4/CD8),并对SCAP组体内VA水平及以上指标的相关性进行分析。结果 3组性别和年龄差异无统计学意义;血清中VA的平均含量分别为0.36、0.25和0.19 mg/L,CAP组VA的含量较对照组明显降低,且SCAP组明显低于MCAP组( $P$ <0.05)。根据WHO推荐的VA诊断标准,3组VA临床缺乏/亚临床缺乏率分别为10.00%、36.67%和61.90%,差异有统计学意义( $P$ <0.05)。CAP组血清中Ig水平较对照组明显降低,且SCAP组明显低于MCAP组( $P$ <0.05)。SCAP组血中总T淋巴细胞、CD4、CD8和CD4/CD8的平均水平分别为53.28%、30.26%、20.24%和1.59;分析VA水平与免疫相关指标关系发现VA水平与Ig(IgG、IgA、IgM)水平、总T淋巴细胞、CD4呈正相关,与CD8水平不相关。结论肺炎患儿血清VA水平与病情严重程度及机体免疫功能相关。

关键词: 社区获得性肺炎, 维生素A, 免疫功能

Abstract:

Objective This study aimed to explore the correlation between serum vitamin A (VA) and immune function in children with community acquired pneumonia (CAP), and to provide information for the risk of pneumonia. Methods Totally 63 cases severe CAP (SCAP group) admitted to the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Xinxiang Medical College, 30 cases in mild CAP (MCAP group), and 30 synchronous healthy children (control group) were enrolled. The serum levels of VA and immunoglobulin (Ig) IgG, IgA, and IgM, and T lymphocyte subsets (total T lymphocytes, CD4, CD8, CD4/CD8) in all patients were detected, The correlation between the VA level and immune-related indicators in SCAP group was assessed. Results Difference was not statistically significant in gender and age among the three groups. The average content of serum VA in the control group, MCAP group, and SCAP group were 0.36, 0.25, and 0.19 mg/L respectively. The content of VA in the two CAP group was significantly lower than the control group, and SCAP group was common ( $P$ <0.05). According to the VA diagnostic criteria recommended by the World Health Organization's (WHO), the rate of clinical/subclinical deficiency of VA in the control group, MCAP group, and SCAP group were 10.00%,36.67%, and 61.90%, respectively; and there was a significant difference among the three groups ( $P$ <0.05). The serum LG level in the two CAP group was significantly lower than that in the control group; and the SCAP group was significantly lower than the MCAP group ( $P$ <0.05);The serum levels of total T lymphocytes, CD4, CD8, and CD4/CD8 in SCAP group were 53.28%,30.26%, 20.24%, and 1.59, respectively.The analysis of the relationship between VA levels and immune-related indicators found that VA levels were positively correlated with Ig (IgG, IgA, IgM) levels, total T lymphocytes, and CD4, but were not correlated with CD8 levels. Conclusion The level of serum VA in children with CAP was associated with the risk of pneumonia and the immune function.

Key words: community acquired pneumonia, vitamin A, immune function

中图分类号:

R563.1

张栋, 王志远, 李树军. 儿童社区获得性肺炎血清维生素A的变化及与免疫功能相关性[J]. 临床荟萃, 2022, 37(7): 623-626.

Zhang Dong, Wang Zhiyuan, Li Shujun. Changes of vitamin A in children with community-acquired pneumonia and corresponding immune function[J]. Clinical Focus, 2022, 37(7): 623-626.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.07.007

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I7/623

图/表 4

表1 3组性别、年龄及VA水平比较

组别	例数	性别[例(%)]		年龄 (月)	VA (mg/L)
组别	例数	男	女	年龄 (月)	VA (mg/L)
对照组	30	17(56.7)	13(43.0)	10(2,24)	0.36±0.03
MCAP组	30	15(50.0)	15(50.0)	9(2,16)	0.25±0.02
SCAP组	63	38(60.3)	25(39.7)	8(3,12)	0.19±0.01
统计值		χ²=0.883		$K W$ =0.875	$F$ =27.61
$P$ 值		0.643		0.266	<0.05

表1 3组性别、年龄及VA水平比较

组别	例数	性别[例(%)]		年龄 (月)	VA (mg/L)
组别	例数	男	女	年龄 (月)	VA (mg/L)
对照组	30	17(56.7)	13(43.0)	10(2,24)	0.36±0.03
MCAP组	30	15(50.0)	15(50.0)	9(2,16)	0.25±0.02
SCAP组	63	38(60.3)	25(39.7)	8(3,12)	0.19±0.01
统计值		χ²=0.883		$K W$ =0.875	$F$ =27.61
$P$ 值		0.643		0.266	<0.05

表2 3组血清中VA及临床缺乏/亚临床缺乏检出率比较[例(%)]

组别	例数	临床/亚临床缺乏	可疑亚临床缺乏	正常
对照组	30	3(10.00)	10(33.33)	17(56.67)
MCAP组	30	11(36.67)	13(43.33)	6(20.00)
SCAP组	63	39(61.90)	15(23.81)	9(14.29)
χ²值			22.99
$P$ 值			<0.05

表2 3组血清中VA及临床缺乏/亚临床缺乏检出率比较[例(%)]

组别	例数	临床/亚临床缺乏	可疑亚临床缺乏	正常
对照组	30	3(10.00)	10(33.33)	17(56.67)
MCAP组	30	11(36.67)	13(43.33)	6(20.00)
SCAP组	63	39(61.90)	15(23.81)	9(14.29)
χ²值			22.99
$P$ 值			<0.05

表3 3组血清中IgG、IgA和IgM的含量比较( x -±s)

组别	例数	IgG(g/L)	IgA(g/L)	IgM(g/L)
对照组	30	10.20±0.81	1.42±0.17	1.46±0.15
MCAP组	30	7.20±0.52^*	0.88±0.16^*	1.01±0.09^*
SCAP组	63	5.33±0.44^*#	0.30±0.04^*#	0.75±0.06^*#
$F$ 值		18.24	25.89	14.33
$P$ 值		<0.05	<0.05	<0.05

表3 3组血清中IgG、IgA和IgM的含量比较( x -±s)

组别	例数	IgG(g/L)	IgA(g/L)	IgM(g/L)
对照组	30	10.20±0.81	1.42±0.17	1.46±0.15
MCAP组	30	7.20±0.52^*	0.88±0.16^*	1.01±0.09^*
SCAP组	63	5.33±0.44^*#	0.30±0.04^*#	0.75±0.06^*#
$F$ 值		18.24	25.89	14.33
$P$ 值		<0.05	<0.05	<0.05

表4 SCAP患儿血清VA水平与免疫指标的相关性分析

指标	$r$ 值	$P$ 值
IgG	0.454	<0.05
IgA	0.518	<0.05
IgM	0.474	<0.05
总T淋巴细胞(%)	0.449	<0.05
CD4(%)	0.372	<0.05
CD8(%)	-0.02	0.927

表4 SCAP患儿血清VA水平与免疫指标的相关性分析

指标	$r$ 值	$P$ 值
IgG	0.454	<0.05
IgA	0.518	<0.05
IgM	0.474	<0.05
总T淋巴细胞(%)	0.449	<0.05
CD4(%)	0.372	<0.05
CD8(%)	-0.02	0.927

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