【摘要】 目的 探讨手足口病(HFMD)并脓毒症及严重脓毒症患儿各免疫指标的变化以及对预后的影响。方法:279例HFMD重症病例分为感染组、脓毒症组、严重脓毒症组,均于入院时检测CD3+、CD4+、CD8+淋巴细胞百分比值、血清免疫球蛋白IgA、IgG、IgM、IgE和补体C3、C4水平。结果 严重脓毒症组的CD3+、CD4+淋巴细胞百分比值显著低于脓毒症组(均P<0.01),脓毒症组的CD3+、CD8+淋巴细胞百分比值均显著低于HFMD感染组(均P<0.05),感染组、脓毒症组、严重脓毒症组三组比较血清免疫球蛋白IgA、IgG、IgM、IgE和补体C3、C4水平差异并无统计学意义(P>0.05);死亡组与存活组比较,CD3+、CD4+淋巴细胞百分比值和补体C3明显降低(P<0.01);将入院前已发热天数相同患儿根据有无合并脓毒症分为脓毒症组与感染组分别进行比较,已发热1d患儿仅IgM差异有统计学意义(P<0.05),已发热2d患儿仅CD8+差异有统计学意义(P<0.01),已发热3天患儿CD3+差异有统计学意义(P<0.05),已发热4天患儿IgG差异有统计学意义(P<0.05)。结论 重症HFMD患儿合并脓毒症时细胞免疫和体液免疫均有改变,免疫状态在疾病的不同阶段、不同严重程度表现不同,但无论细胞免疫还是体液免疫,合并脓毒症时主要表现为抑制状态。更多还原

【Abstract】 Objective To investigate the changes of cellular and humoral immunity and their effects on the prognosis of hand,foot and mouth disease(HFMD) complicated with sepsis.Methods Two hundreds and seventy-nine cases of severe HFMD were divided into 3 groups according to their specific conditions:155 infected with HFMD only(infection group),108 cases complicated with sepsis,and 16 cases complicated with severe sepsis.Peripheral blood samples were collected to examine the percentages of CD3+,CD4+,and CD8+ lymphocytes and serum lev3 els of IgA,IgG,IgM,and IgE,and complements C3 and C4 immediately after admission to hospital.Results The percentages of CD3+and CD4+ lymphocytes of the severe sepsis groups were significantly lower than those of the sepsis group(both P<0.01),The percentages of CD3+and CD8+ lymphocytes of the sepsis groups were significantly lower than those of the infection group(both P<0.05).There were not significant differences in the levels of IgA,IgG,IgM,and IgE and complements C3 and C4(all P>0.05) among these 3 groups.The peercentages of CD3+,CD4+ and complement C3 level of of the dying group were all significantly lower than those of the survival group(all P<0.001).According to the fever duration before admission,the children with HFMD were divided into 6 groups.Then based on with and without sepsis,divided into infection subgroup and sepsis subgroup.Compared with the infection subgroup,1 day after the onset of fever,only the IgM level was significantly lower,2days after the onset of fever only the CD8 + level was significantly lower,3 days after only the CD3+ level was significantly lower,and 4 days after only the IgG level was significantly lower(P<0.05 or P<0.01).Conclusion Although the immune state of HFMD with sepsis is different at different disease state and severity,both the cellular immunity and humoral immunity appear suppressive in HFMD complicated with sepsis mainly.更多还原