本文選題：兒童 + 下呼吸道感染��； 參考：《蘇州大學(xué)》2012年碩士論文

【摘要】：目的：研究CD4~+CD25~+FoxP3~+T調(diào)節(jié)細(xì)胞、白細(xì)胞介素-10（Interleukin-10，IL-10）、嗜酸性粒細(xì)胞和嗜堿性粒細(xì)胞在3歲以下兒童不同臨床特征急性下呼吸道感染（Lower respiratory tract infection，LRTI）外周血的不同表達(dá)。評(píng)價(jià)其在有喘息表現(xiàn)LRTI患兒中的價(jià)值，并探討有喘息癥狀的LRTI與支氣管哮喘的內(nèi)在關(guān)聯(lián)。 方法：選取蘇州大學(xué)附屬兒童醫(yī)院呼吸科2011年8月～2012年1月間收治的113例住院前未使用過糖皮質(zhì)激素的LRTI患兒，根據(jù)以往有無醫(yī)生診斷為特應(yīng)性皮炎、入院時(shí)是否有喘息和哮喘預(yù)測(cè)指數(shù)進(jìn)行分組，并選取19例健康兒童為對(duì)照組。入院后進(jìn)行多病原學(xué)檢測(cè)，并留取患兒外周血標(biāo)本，分別采用流式細(xì)胞儀檢測(cè)CD4~+CD25~+FoxP3~+Treg的比例、酶聯(lián)免疫吸附試驗(yàn)（ELISA）檢測(cè)IL-10水平、血細(xì)胞分析儀檢測(cè)患兒嗜酸性粒細(xì)胞和嗜堿性粒細(xì)胞的比例。 結(jié)果：（1）LRTI患兒以病毒感染為主，呼吸道合胞病毒感染占首位，LRTI患兒外周血嗜堿性粒細(xì)胞比例、CD4~+CD25~+FoxP3~+Treg比例和IL-10表達(dá)水平要高于對(duì)照組，而嗜酸性粒細(xì)胞比例要低于對(duì)照組。差異均有統(tǒng)計(jì)學(xué)意義（P0.05）。 （2）在所有LRTI患兒中，有特應(yīng)性皮炎史患兒外周血CD4~+CD25~+FoxP3~+Treg比例低于無特應(yīng)性皮炎史患兒，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；有特應(yīng)性皮炎史患兒外周血嗜堿性粒細(xì)胞比例、嗜酸性粒細(xì)胞比例和IL-10表達(dá)水平與無特應(yīng)性皮炎史患兒比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 （3）在所有LRTI患兒中，喘息患兒外周血IL-10含量高于無喘息患兒，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；喘息患兒外周血嗜酸性粒細(xì)胞比例、嗜堿性粒細(xì)胞比例和CD4~+CD25~+FoxP3~+Treg比例與無喘息患兒比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 （4）在所有入選兒童中，有特應(yīng)性皮炎史喘息組、有特應(yīng)性皮炎史非喘息組、無特應(yīng)性皮炎史喘息組和無特應(yīng)性皮炎史非喘息組患兒外周血嗜酸性粒細(xì)胞比例均低于對(duì)照組，差異具統(tǒng)計(jì)學(xué)意義（P0.0033），其他各組間外周血嗜酸性粒細(xì)胞比例兩兩比較差異均無統(tǒng)計(jì)學(xué)意義（P0.0033）；有特應(yīng)性皮炎史喘息組和有特應(yīng)性皮炎史非喘息組患兒外周血嗜堿性粒細(xì)胞比例均高于對(duì)照組，差異具統(tǒng)計(jì)學(xué)意義（P0.0033），其他各組間嗜堿性粒細(xì)胞比例兩兩比較差異均無統(tǒng)計(jì)學(xué)意義（P0.0033）；哮喘預(yù)測(cè)指數(shù)陽性患兒外周血CD4~+CD25~+FoxP3~+Treg的比例要高于對(duì)照組但低于其他各組，對(duì)照組兒童外周血CD4~+CD25~+FoxP3~+Treg比例低于其他各組，差異具統(tǒng)計(jì)學(xué)意義（P0.0033），其余各組間CD4~+CD25~+FoxP3~+Treg比例兩兩比較差異均無統(tǒng)計(jì)學(xué)意義（P0.0033）；哮喘預(yù)測(cè)指數(shù)陽性患兒和喘息有特應(yīng)性皮炎史患兒外周血IL-10含量均高于健康對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P0.0033），其他各組間外周血IL-10含量?jī)蓛杀容^差異均無統(tǒng)計(jì)學(xué)意義（P0.0033）。 結(jié)論：CD4~+CD25~+FoxP3~+Treg、IL-10、嗜酸性粒細(xì)胞和嗜堿性粒細(xì)胞均參與了兒童LRTI的發(fā)病機(jī)制；LRTI時(shí)外周血IL-10含量較高可能與喘息發(fā)生有關(guān)；LRTI時(shí)外周血CD4~+CD25~+FoxP3~+Treg比例升高是機(jī)體的免疫防御表現(xiàn)的一部分，哮喘預(yù)測(cè)指數(shù)陽性患兒發(fā)生急性喘息性LRTI時(shí)，，外周血CD4~+CD25~+FoxP3~+Treg比例升高受損，CD4~+CD25~+FoxP3~+Treg可作為哮喘預(yù)測(cè)指數(shù)陽性兒童早期喘息治療靶點(diǎn)。
[Abstract]:Objective: To study the regulation of CD4~+CD25~+FoxP3~+T cells, interleukin -10 (Interleukin-10, IL-10), eosinophils and basophils in children under the age of 3 different clinical features of acute lower respiratory tract infection (Lower respiratory tract infection, LRTI) expression in peripheral blood. To evaluate the performance of LRTI in asthmatic children. The value, and to explore the relationship between LRTI and asthma have wheezing symptoms.
Methods: from August 2011 to January 2012 in the Department of respiration of Children's Hospital Affiliated to Suzhou University from 113 inpatients before not used glucocorticoid LRTI patients, according to previous doctors diagnosed with atopic dermatitis, whether there is wheezing and asthma predictive index of group, and selected 19 cases of healthy children as control group. After admission of detection of pathogens, and take the children's peripheral blood specimens were detected by flow cytometry CD4~+CD25~+FoxP3~+Treg ratio, enzyme-linked immunosorbent assay (ELISA) detection of IL-10 level detection in children with blood cell analyzer of eosinophils and basophils.
Results: (1) LRTI patients with viral infection of respiratory syncytial virus infection first, LRTI patients peripheral blood basophils in proportion, the expression level of CD4~+CD25~+FoxP3~+Treg and the ratio of IL-10 was higher than that of the control group, while the proportion of eosinophils is lower than the control group. The differences were statistically significant (P0.05).
(2) in all LRTI patients, a history of atopic dermatitis in peripheral blood of children with CD4~+CD25~+FoxP3~+Treg was lower than that of non atopic dermatitis in children, the difference was statistically significant (P0.05); a history of atopic dermatitis in children with peripheral blood basophils, eosinophils ratio and IL-10 expression with no history of atopic dermatitis in children with no significant difference (P0.05).
(3) in all children with LRTI, the content of IL-10 in peripheral blood of children with wheezing and wheezing were higher than those without, the difference was statistically significant (P0.05); wheezing in children with peripheral blood eosinophil percentage, no significant basophilic cell proportion and CD4~+CD25~+FoxP3~+Treg ratio with no wheezing difference (P0.05).
(4) in all the children, have a history of atopic dermatitis in wheezing group, atopic dermatitis in the history of non wheezing group, non atopic asthmatic group and no history of atopic dermatitis in children with history of non wheezing group peripheral blood eosinophil percentage was lower than the control group, the difference was statistically significant (P0.0033), the difference between the other groups of peripheral blood eosinophils proportion 22 had no statistical significance (P0.0033); a history of atopic dermatitis in wheezing group and atopic dermatitis in the history of non wheezing group in peripheral blood neutrophils alkaline ratio were higher than the control group, the difference was statistically significant (P0.0033), the difference between the other groups of basophils in the proportion of 22 were not statistically significant (P0.0033); Asthma Predictive Index of children with positive peripheral blood CD4~+CD25~+FoxP3~+Treg ratio was higher than that of the control group but lower than the other groups, the control group in peripheral blood of children CD4~+CD25~+FoxP3~ The +Treg ratio is lower than the other groups, the difference was statistically significant (P0.0033), CD4~+CD25~+FoxP3~+Treg ratio of 22 other groups showed no significant difference (P0.0033); Asthma Predictive Index positive children with atopic dermatitis and wheezing history in children with peripheral blood IL-10 content were higher than that of the control group, the difference was statistically significant (P0.0033). Other groups of IL-10 in peripheral blood of 22 showed no significant difference (P0.0033).
Conclusion: CD4~+CD25~+FoxP3~+Treg, IL-10, the pathogenesis of eosinophils and basophils are involved in childhood LRTI; peripheral blood IL-10 content may be associated with wheezing LRTI; LRTI increased the proportion of peripheral blood CD4~+CD25~+FoxP3~+Treg is a part of the body's immune defense performance, predictive index positive children with acute asthma asthmatic LRTI, peripheral blood CD4~+CD25~+FoxP3~+Treg increased damage, CD4~+CD25~+FoxP3~+Treg can be used as a predictive index of early wheezing asthma treatment target positive children.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.6

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