本文選題：嬰幼兒喘息 + 髓系抑制細(xì)胞��； 參考：《鄭州大學(xué)》2013年碩士論文

【摘要】：喘息是小兒最常見的呼吸道癥狀,小兒喘息性疾病是指有一組具有喘息癥狀的呼吸道綜合征,由于年齡特異的病理生理特點(diǎn),喘息在嬰幼兒中常常反復(fù)發(fā)生,部分喘息是兒童哮喘的早期表現(xiàn),但是目前嬰幼兒喘息的發(fā)病機(jī)制尚不清楚。對于正在喘息發(fā)作的患兒來講,判斷是暫時(shí)性的喘息還是哮喘,仍是兒科臨床工作中的難題。 目的 檢測毛細(xì)支氣管炎和反復(fù)喘息患兒外周血髓系抑制細(xì)胞(myeloid-derived suppressor cells,MDSCs)占單個(gè)核細(xì)胞比例、血清白介素10(Interleukin-10, IL-10)及血清白介素12(Interleukin-12, IL-12)水平,初步探討其在嬰幼兒喘息中的發(fā)病機(jī)制及其關(guān)系。 材料和方法 研究對象分為4組：毛細(xì)支氣管炎組(毛支組)、反復(fù)喘息組(喘息組)、非感染對照組、肺炎對照組。選擇從2010年10月至2012年6月就診于鄭大三附院兒內(nèi)科門診或病房住院的毛細(xì)支氣管炎急性期患兒99例(男51例,女48例),年齡3月-2歲,平均年齡是1歲6月,至少具有高危因素之一的患兒52例為毛支Ⅰ組,無高危因素的患兒47例為毛支Ⅱ組(特應(yīng)質(zhì)高危因素是指：患兒自身有醫(yī)生診斷的包括變應(yīng)性皮炎、變應(yīng)性鼻炎等變應(yīng)性疾病或者父母雙方 或一方患有哮喘疾病史者)。同期選擇急性發(fā)作期反復(fù)喘息患兒(均在過去的12個(gè)月內(nèi)至少有3次喘息及以上發(fā)作或過去6個(gè)月內(nèi)至少有2次喘息及以上發(fā)作)103例(男51例,女52例),年齡7月-2歲1月,平均年齡是1歲7月,根據(jù)我國2008年制定《兒童支氣管哮喘診斷與防治指南》[’]中哮喘預(yù)測指數(shù)標(biāo)準(zhǔn),將哮喘預(yù)測指數(shù)陽性的患兒入喘息Ⅰ組(50例),哮喘預(yù)測指數(shù)陰性的患兒入喘息Ⅱ組(53例)。隨機(jī)選取同期本院同年齡組外科患疝氣、腎結(jié)石等非感染性疾病術(shù)前患兒54例(男28例,女26例)作為非感染對照組,年齡6月-2歲4月,平均年齡1歲7月。選擇同期在我院在門診就診或住院診斷為肺炎的患兒50例(男25例,女25例)作為支氣管肺炎對照組,年齡6個(gè)月～2歲3月,平均1歲8月,均無特應(yīng)質(zhì)高危因素。各組兒童年齡、性別比較差異均無統(tǒng)計(jì)學(xué)意義(Pa0.05),各組兒童均為足月出生,排除腫瘤患兒,排除氣道發(fā)育畸形患兒,近2周無感染疾病史,無免疫調(diào)節(jié)劑使用史,其家長均知情同意并征得醫(yī)院倫理委員會同意。 采用流式細(xì)胞術(shù)檢測MDSCs在外周血單核細(xì)胞中的比例,采用ELISA(酶聯(lián)免疫吸附實(shí)驗(yàn))法檢測外周血血清中IL-10、IL-12水平。 統(tǒng)計(jì)學(xué)分析采用SPSS17.0統(tǒng)計(jì)軟件完成,各組資料以(x±S)表示,組間差異性分析采用單因素方差分析、Bonferroni方法檢驗(yàn),相關(guān)分析采用Pearson直線相關(guān)分析,以a=0.05作為統(tǒng)計(jì)學(xué)的檢驗(yàn)水準(zhǔn)。 結(jié)果 1.喘息Ⅰ組較喘息Ⅱ組相比,外周血MDSCs%、血清IL-10水平顯著升高,血清IL-12水平顯著降低(P0.05)；喘息Ⅱ組較肺炎對照組、非感染對照組相比,外周血MDSCs%、血清IL-10水平顯著升高,血清IL-12水平顯著降低(P0.05)。 2.毛支Ⅰ組較毛支Ⅱ組相比,外周血MDSCs%、血清IL-10水平顯著升高,血清IL-12水平顯著降低(P0.05)；毛支Ⅱ組較肺炎對照組、非感染對照組相比,外周血MDSCs%、血清IL-10水平升高,血清IL-12水平顯著降低(P0.05)。 3.喘息Ⅰ組較毛支Ⅰ組相比,外周血MDSCs%、血清IL-10水平、IL-12水平均無明顯差異(P0.05)；喘息Ⅱ組較毛支Ⅱ組相比,外周血MDSCs%、血清IL-10水平、血清IL-12水平均無明顯差異(P0.05)。 4.肺炎對照組與非感染對照組相比,外周血MDSCs%、血清IL-10水平、IL-12水平無明顯差異(P0.05)。 5.相關(guān)性分析：喘息組Ⅰ組和毛支Ⅰ組外周血MDSCs%和血清IL-10水平存在正相關(guān),與血清IL-12水平呈負(fù)相關(guān),喘息Ⅱ組、毛支Ⅱ組、肺炎對照組及非感染對照組MDSCs%與血清IL-10水平、血清IL-12水平均無相關(guān)性。 結(jié)論 MDSCs可能通過上調(diào)IL-10水平,下調(diào)IL-12水平參與毛細(xì)支氣管炎、反復(fù)喘息的發(fā)病機(jī)制。
[Abstract]:Wheezing is the most common respiratory symptom in children. Children's wheezing disease refers to a group of respiratory syndrome with wheezing symptoms. Due to age specific pathophysiology, wheezing often occurs repeatedly in infants and infants. Partial wheezing is an early manifestation of asthma in children, but the pathogenesis of infant wheezing is not yet clear. For children who are wheezing, judging whether they are transient wheezing or asthma is still a difficult problem in pediatric clinical work.
objective
The ratio of myeloid-derived suppressor cells (MDSCs) to mononuclear cells, serum interleukins 10 (Interleukin-10, IL-10) and serum interleukins 12 (Interleukin-12, IL-12) were detected in children with bronchiolitis and recurrent wheezing, and the pathogenesis and relationship of them in infants' wheezing were preliminarily discussed.
Materials and methods
The subjects were divided into 4 groups: the bronchiolitis group (Mao Zhizu), the repeated wheezing group (wheezing group), the non infected control group and the pneumonia control group. 99 cases (51 males and 48 females) were selected from October 2010 to June 2012 in the acute period of bronchiolitis hospitalized in the outpatient department of the Affiliated Hospital of Zheng Dasan Affiliated Hospital (51 males and 48 females), and the average age was -2 years old in the age of March. At least 1 years old in June, 52 children with at least one high risk factor were group I, and 47 cases with no high risk factors were group II Group (high risk factors of idiopathic allergic dermatitis, allergic rhinitis, allergic rhinitis, etc.).
Children with a history of asthma). At the same time, children with recurrent wheezing during the period of acute attack (at least 3 wheezing and above in the past 12 months or at least 2 wheezing or more episodes in the past 6 months in the past 6 months), 103 cases (51 men, 52 women), age July January, average age is 1 year July, according to our country in 2008 The guidelines for the diagnosis and prevention of bronchial asthma in the Guide > [/] index of asthma prediction index, children with positive asthma predictive index were enrolled in group I (50 cases), and children with negative asthma predictive index were enrolled in group II (53 cases). 54 cases of non infectious diseases such as surgical hernia and kidney stones in the same age group were randomly selected (28 men and 26 women). As a non infected control group, the average age of June -2 years was 1 years old in April, the average age was 1 years old in July. 50 children (25 men and 25 women) in our hospital were selected as the control group of bronchopneumonia in the same period. The age of 6 months to 2 years March and the average of 1 years in August were 1. There was no statistical significance (Pa0.05). All children were born in full term, excluding children with cancer, excluding children with airway malformation, no history of infection in the last 2 weeks, no history of use of immunomodulators, their parents informed consent and agreed with the hospital ethics committee.
The proportion of MDSCs in peripheral blood mononuclear cells was detected by flow cytometry, and the level of IL-10 and IL-12 in peripheral blood serum was detected by ELISA (enzyme-linked immunosorbent assay).
Statistical analysis was performed with SPSS17.0 statistical software. The data of each group were expressed as (x + S). The difference analysis between groups was analyzed by single factor analysis of variance, Bonferroni method was tested, and the correlation analysis was analyzed by Pearson linear correlation, and a=0.05 was used as a statistical test.
Result
1. compared with group II group, the level of serum IL-10 was significantly increased in peripheral blood and serum IL-12 level was significantly decreased (P0.05) in peripheral blood MDSCs%, compared with that in control group, MDSCs% in peripheral blood was significantly higher than that in control group, and serum IL-10 level was significantly increased, and serum IL-12 level decreased significantly (P0.05).
Compared with group II, the level of serum IL-10 and serum IL-12 were significantly higher in group 2. group I than in group II group, and serum IL-12 level was significantly decreased (P0.05). Compared with the control group, the peripheral blood MDSCs%, serum IL-10 level and serum IL-12 level were significantly decreased (P0.05) in the hair Branch II group compared with the control group.
3. compared with the hair branch I group, there was no significant difference in peripheral blood MDSCs%, serum IL-10 level and IL-12 level (P0.05) compared with the group I group (P0.05), and there was no significant difference between the peripheral blood MDSCs%, the serum IL-10 level and the serum IL-12 level in the panting group II group compared with the group II Group (P0.05).
4. there was no significant difference in peripheral blood MDSCs%, serum IL-10 level and IL-12 level between the pneumonia control group and the non infection control group (P0.05).
5. correlation analysis: there was a positive correlation between MDSCs% and serum IL-10 level in group I group I and group I, and negative correlation with serum IL-12 level. Group II, group II, pneumonia control group and non infected control group had no correlation with serum IL-10 level and serum IL-12 level.
conclusion
MDSCs may play an important role in the pathogenesis of bronchiolitis and recurrent wheezing by up regulating IL-10 level and downregulating IL-12 level.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R725.6

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