【摘要】 目的通过检测更昔洛韦治疗前后巨细胞病毒(cytomegalovirus,CMV)肝炎婴儿血清IL-2、IL-8、IL-10、IFN-γ水平的变化,了解更昔洛韦在CMV肝炎发生、发展和恢复过程中对上述细胞因子的影响,探讨其对机体免疫功能的影响及作用机制。方法采用ELISA法检测72例患儿血清CMV-IgM,定量PCR检测血CMVDNA,两者均为阳性,而ALT正常者作为观察组1;伴有ALT异常者作为观察组2;正常健康体检婴儿作为健康对照组。采用ELISA法检测3组血清IL-2、IL-10、IL-8、IFN-γ水平,并对观察组2采用更昔洛韦治疗后再检测上述细胞因子水平。结果(1)与健康对照组比较,观察组1患儿血清IL-8、IL-10均显著升高(t=3.74,9.56,P<0.01),IL-2显著降低(t=5.87,P<0.01)。(2)观察组2患儿血清IFN-γ与健康对照组比较显著升高(t=5.93,P<0.01),而观察组1患儿与健康对照组儿童血清IFN-γ比较无统计学差异(t=0.86,P>0.05)。(3)观察组2患儿经更昔洛韦治疗后,血清IL-2水平较观察组1显著增高(t=3.41,P<0.01),而血清IL-8、IL-10、IFN-γ水平则恢复至接近建康对照组儿童水平,两者比较均无显著性差异(t=0.74,0.36,0.54,P>0.05)。(4)观察组2用药前后自身对照比较,血清IL-8、IL-10、IFN-γ水平显著下降(t=6.52,7.24,14.23,P<0.01),血清IL-2水平显著升高(t=5.78,P<0.01)。(5)观察组2IFN-γ水平与ALT值有较好的正相关性(r=0.76,P<0.01)。结论(1)CMV感染后导致患儿血清中相关细胞因子分泌紊乱,提示机体出现Th1/Th2细胞平衡失调;(2)更昔洛韦除了具有抑制和清除病毒的功能外,还具有改善机体免疫功能的作用,规范使用下安全、可靠、不良反应小。更多还原

【Abstract】 Objective To investigate the changes of serum cytokines IL-2,IL-8,IL-10 and IFN-γ in infants with cytomegalovirus hepatitis before and after ganciclovir treatment,and explore the underlying mechanisms of ganciclovir and the immunological changes in the development and progression of cytomegalovirus(CMV) infection.Methods CMV-IgM in the serum samples of 72 infants with identified cytomegalovirus infection were measured by enzyme-linked immunosorbent assay(ELISA).CMV DNA in blood was measured by quantitative PCR.CMV-IgM(+) and CMV DNA(+) were as observed group 1(35 cases,without hepatitis).Those with abnormality of ALT were regarded as observed group 2(37 cases,with hepatitis).Another 30 matched healthy infants were enrolled as healthy control group.Levels of serum IL-2,IL-10,IL-8 and IFN-γ of each group were examined by ELISA,and CMV masculine hepatitis group were cured with ganciclovir(5mg/kg,i.v.,twice per day for 14 d,and then once per day for 14 d after a 7 days’interval),then the levels of above factors were examined again.Results The levels of IL-8 and IL-10 in observed group 1 were significantly higher than those in healthy control group(t=3.74,9.56;P<0.01),but IL-2 were significantly lower(t=5.87,P<0.01).Compared with healthy control group,the level of IFN-γ in observed group 2 was significantly higher(t=5.93,P<0.01),but that in observed group 1 was not significantly higher(t=0.86,P>0.05).After ganciclovir treatment,the level of IL-2 in observed group 2 was significantly higher than that in observed group 1(t=3.41,P<0.01),then the levels of IL-8,IL-10 and IFN-γ were not significantly different with healthy control group(t=0.74,0.36,0.54;P>0.05).The levels of IL-8,IL-10 and IFN-γ were decreased significantly(t=6.52,7.24,14.23;P<0.01),and that of IL-2 was increased significantly(t=5.78,P<0.01) before and after ganciclovir treatment in observed group 2.The level of IFN-γ showed a positive association with ALT in observed group 2(r=0.76,P<0.01).Conclusion CMV infection results in parasecretion of cytokine,suggesting the dysequilibrium of Thl/Th2;besides the level of IFN-γ is higher,and the degree of height is closely related with the extent of damage of liver.Ganciclovir can not only remove the virus,but also improve immune function,to use it normaly is safe and less side effects.更多还原