2021 年第 12 期 第 16 卷

急性下呼吸道病毒感染后喘息婴幼儿的免疫细胞因子水平和肺功能变化及其相关性分析

Changes of immune cytokines and lung function in infants with acute viral lower respiratory tract infection complicated with wheezing and their correlation analysis

作者：褚亚娟帅金凤李保驰吕文山刘建华黄坤玲赵慧玲霍培卿 张海荣张欢

英文作者：Chu Yajuan Shuai Jinfeng Li Baochi Lyu Wenshan Liu Jianhua Huang Kunling Zhao Huiling Huo Peiqing Zhang Hairong Zhang Huan

单位：河北省儿童医院呼吸科，石家庄050000

英文单位：Department of Respiratory Medicine Children′s Hospital of Hebei Province Shijiazhuang 050000 China

关键词：下呼吸道感染；喘息；免疫细胞因子；肺功能；婴幼儿

英文关键词：Lowerrespiratorytractinfection;Wheezing;Immunecytokines;Lungfunction;Infants

• 摘要：

• 目的 探讨急性下呼吸道病毒感染后喘息婴幼儿的免疫细胞因子和肺功能变化及其相关性。方法 选取河北省儿童医院2018年5月至2019年5月收治的急性下呼吸道病毒感染婴幼儿184例，根据是否出现喘息分为喘息组（105例）和非喘息组（79例）。另选择同期于本院儿童保健科体检健康的儿童80例（健康对照组）。3组儿童均接受肺功能检查和血清免疫细胞因子［白细胞介素2（IL-2）、干扰素γ、肿瘤坏死因子β（TNF-β）、IL-4、IL-5、IL-10］检测。比较3组肺功能指标(达峰时间比、达峰容积比)和血清免疫细胞因子水平，分析喘息组患儿肺功能与血清免疫细胞因子水平的相关性。比较感染不同病毒组喘息患儿肺功能和血清免疫细胞因子水平。喘息患儿随访6个月，比较发展为哮喘和未发展为哮喘患儿入院时和随访6个月时的肺功能和血清免疫细胞因子水平。结果  喘息组和非喘息组患儿入院时达峰时间比和达峰容积比均低于健康对照组，且喘息组均低于非喘息组［(17.8±1.7)%比（28.6±3.0）%，(20.4±2.2)%比（29.4±2.9）%］（均P＜0.05）。喘息组和非喘息组血清IL-2、干扰素γ、TNF-β水平均低于健康对照组，且喘息组均低于非喘息组，而血清IL-4、IL-5、IL-10水平均高于健康对照组，且喘息组均高于非喘息组（均P＜0.05）。合并喘息的急性下呼吸道病毒感染患儿达峰时间比和达峰容积比与血清IL-2、干扰素γ水平均呈正相关，与血清IL-4、IL-10水平均呈负相关（均P＜0.05）。喘息组105例患儿中呼吸道合胞病毒（RSV）感染62例、流感病毒感染15例、腺病毒感染18例、副流感病毒（PIV）感染10例，RSV组和流感病毒组达峰时间比、达峰容积比和血清IL-2、干扰素γ水平均低于腺病毒组和PIV组，血清IL-4和IL-10水平均高于腺病毒组和PIV组（均P＜0.05）。随访6个月，喘息组发展为哮喘19例，未发展为哮喘86例。发展为哮喘组达峰时间比、达峰容积比和血清IL-2、干扰素γ、TNF-β水平均低于入院时，且低于未发展为哮喘组，血清IL-4、IL-5、IL-10水平均高于入院时，且均高于未发展为哮喘组（均P＜0.05）。结论  急性下呼吸道病毒感染后喘息婴幼儿的肺功能较未合并喘息患儿下降，免疫功能紊乱更严重，尤其是RSV、流感病毒感染的喘息患儿更为严重，随访6个月发展为哮喘的患儿免疫功能和肺功能损伤更严重，合并喘息患儿免疫细胞因子水平与肺功能密切相关。

• Objective To investigate the changes and correlation of immune cytokines and lung function in infants with acute viral lower respiratory tract infection complicated with wheezing. Methods From May 2018 to May 2019, 184 infants with acute viral lower respiratory tract infection admitted to Children′s Hospital of Hebei Province were selected. They were divided into the wheezing group (105 cases) and the non-wheezing group (79 cases) according to whether wheezing occurred. Eighty healthy children who underwent physical examination in child healthcare department of the hospital during the same period were selected (healthy control group). Children in the three groups received lung function test and serum immune cytokines ［interleukin-2 (IL-2), interferon-γ (IFN-γ), tumor necrosis factor-β（TNF-β）, IL-4, IL-5 and IL-10］ detection. The lung function indexes ［time to peak tidal expiratory flow (TPTEF)/expiratory time (TE), TPTEF/expiratory volume (VE)］ and serum immune cytokine levels were compared among the three groups, and the correlation between lung function and serum immune cytokine levels in wheezing group was analyzed. The lung function and serum immune cytokine levels were compared among different viral infection groups. The children with wheezing were followed-up for 6 months, the lung function and serum immune cytokine levels on admission and at 6 months of follow-up were compared between the asthma developing group and the asthma non-developing group. Results The TPTEF/TE and TPTEF/VE in wheezing group and non-wheezing group were lower than those in healthy control group on admission, and those in wheezing group were lower than those in the non-wheezing group ［(17.8±1.7)% vs (28.6±3.0)%, (20.4±2.2)% vs (29.4±2.9)%］ (all P<0.05). Serum levels of IL-2, IFN-γ and TNF-β in wheezing group and non-wheezing group were lower than those in healthy control group, and those in wheezing group were lower than those in non-wheezing group, while the serum levels of IL-4, IL-5 and IL-10 in wheezing group and non-wheezing group were higher than those in healthy control group, and those in wheezing group were higher than those in non-wheezing group (all P<0.05). TPTEF/TE and TPTEF/VE were positively correlated with the serum levels of IL-2 and INF-γ, and negatively correlated with the serum levels of IL-4 and IL-10 in children with acute viral lower respiratory tract infection complicated with wheezing (all P<0.05). In wheezing group, there were 62 cases of respiratory syncytial virus (RSV) infection, 15 cases of infulenza virus infection, 18 cases of adenovirus infection and 10 cases of paranifuenza virus (PIV) infection among 105 infants. The TPTEF/TE, TPTEF/VE and serum levels of IL-2 and INF-γ in RSV group and influenza virus group were lower than those in adenovirus group and PIV group, while serum levels of IL-4 and IL-10 in RSV group and influenza virus group were higher than those in adenovirus group and PIV group (all P<0.05). At 6 months of follow-up, 19 cases developed asthma and 86 cases did not develop asthma in wheezing group. The TPTEF/TE, TPTEF/VE and serum levels of IL-2, INF-γ and TNF-β in asthma developing group were lower than those on admission and those in asthma non-developing group, while serum levels of IL-4, IL-5 and IL-10 were higher than those on admission and those in asthma non-developing group (all P<0.05). Conclusions   The lung function of infants with acute viral lower respiratory tract infection complicated with wheezing is lower than that of infants without wheezing, and the immune dysfunction is more serious, especially in the wheezing infants with RSV and influenza virus infection. The immune function and lung function damage are more serious in infants with asthma at 6 months of follow-up, and the immune cytokines are closely related to lung function in infants with wheezing.