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目的检测甲型H1N1流感患儿Th细胞亚群的动态变化,探讨甲型H1N1流感的发病机制,并评价患儿的免疫状况及与疾病严重程度和预后的关系。方法总结19例甲型H1N1流感患儿Th细胞亚群动态变化,选择21例健康儿童作为健康对照组。采用流式细胞仪计数INF-γ+细胞占CD3+CD8-T细胞百分比(Th1%)和IL-4+占CD3+CD8-T细胞百分比(Th2%),并计算Th1与Th2的比值。结果 19例甲型H1N1流感患儿中,存活15例(78.9%),死亡4例(21.1%)。健康对照组、存活组和死亡组三组儿童性别、年龄无显著性差异;入院时,甲型H1N1流感患儿存活组和死亡组Th1%、Th2%和Th1/Th2分别为6.65%(0.62%～25.30%)vs.7.26%(4.66%～14.03%)、1.40%(0.31%～5.41%)vs.1.69%(1.52%～2.42%)、6.15%(2.0%～14.46%)和3.84%(3.03%～7.67%),Th1%较健康对照组无明显改变,Th2%显著升高、Th1/Th2显著下降(P均<0.01);存活的甲型H1N1流感患儿Th1%逐渐升高,Th1/Th2比例有可逆性下降,最终升高;而同期死亡者Th1/Th2比例不可逆性下降,直至死亡,较存活组和健康组有显著性差异(P<0.05)。结论甲型H1N1流感急性期为Th2细胞占优势型,存在免疫抑制;Th1/Th2的平衡可以影响机体的免疫状态,动态监测还可对疾病的程度和预后做出判断。
Objective To investigate the dynamic changes of Th cell subsets in children with influenza A (H1N1) and to explore the pathogenesis of Influenza A (H1N1) and to evaluate the relationship between the immune status of children and the severity and prognosis of the disease. Methods Th1 subgroups of 19 children with influenza A (H1N1) were retrospectively analyzed. 21 healthy children were selected as healthy control group. The percentage of INF-γ + cells in CD3 + CD8-T cells (Th1%) and IL-4 + CD3 + CD8-T cells (Th2%) were counted by flow cytometry and the ratio of Th1 to Th2 was calculated. Results Of the 19 cases of children with influenza A (H1N1), 15 (78.9%) survived and 4 died (21.1%). There was no significant difference in sex and age between healthy control group, survival group and death group. Th1%, Th2% and Th1 / Th2 of survival and death group of children with influenza A (H1N1) were 6.65% (0.62% ~ 25.30%) vs.7.26% (4.66% ~ 14.03%), 1.40% (0.31% ~ 5.41%) vs.1.69% (1.52% ~ 2.42%), 6.15% (2.0% ~14.46%) and 3.84% Th1%, Th1%, Th1%, Th1%, Th1%, Th1%, Th1%, Th1%, Th1% and Th1% / Th2 decreased reversibly and eventually increased. However, the proportion of Th1 / Th2 in the same period of death decreased irreversibly until death, compared with the survivors and healthy controls (P <0.05). Conclusions The acute phase of influenza A (H1N1) is predominant type of Th2 cells with immunosuppression. The balance of Th1 / Th2 may affect the immune status of the organism. Dynamic monitoring can also make judgments on the degree and prognosis of the disease.