本文選題：兒童阻塞性睡眠呼吸暫停低通氣綜合征 + T淋巴細(xì)胞亞群�。� 參考：《寧夏醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的研究OSAHS兒童手術(shù)干預(yù)前后外周血中T淋巴細(xì)胞亞群及NK細(xì)胞活性的變化,評估手術(shù)干預(yù)對OSAHS兒童免疫功能的影響。 方法選取2010年3月—2010年6月經(jīng)整夜多導(dǎo)睡眠監(jiān)測儀(PSG)確診的OSAHS兒童36例,分別采集術(shù)前24～48h、扁桃體、腺樣體切除術(shù)術(shù)后3個月及隨訪6個月的外周血樣本,并選取30例年齡、性別匹配的排除相關(guān)疾病的健康兒童作為對照組。采用流式細(xì)胞術(shù)檢測外周血中CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性的水平,同時記錄OSAHS兒童術(shù)前、手術(shù)干預(yù)3個月和隨訪6個月時PSG中LSaO_2、AHI的監(jiān)測結(jié)果。并分別與健康兒童相比較。 結(jié)果(1)與健康兒童比較:①OSAHS兒童術(shù)前外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性顯著減低(P0.01),而外周血CD8~+的百分率顯著升高(P0.01);②治療3月后,外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性比較差異具有統(tǒng)計學(xué)意義(P0.01),但與OSAHS兒童術(shù)前比較差異無統(tǒng)計學(xué)意義(P0.05);③隨訪6個月后,外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性與健康兒童比較差異無統(tǒng)計學(xué)意義(P0.05);④OSAHS組術(shù)前PSG中LSaO_2顯著減低(P0.05),而AHI顯著升高(P0.01);⑤治療3月后,夜間LSaO_2升高,而AHI減低,但與健康兒童比較差異具有統(tǒng)計學(xué)意義(P0.05)。⑥隨訪6個月后,夜間LSaO_2及AHI與健康兒童比較差異無統(tǒng)計學(xué)意義(P0.01)。(2)直線相關(guān)分析顯示:OSAHS組術(shù)前、術(shù)后外周血CD3~+、CD4~+、CD8~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性與LSaO_2、AHI的變化有一定線性關(guān)系。隨著夜間LSaO_2百分?jǐn)?shù)的升高,外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性均升高,且CD8~+的百分率減低。同時隨著AHI的降低,OSAHS兒童外周血CD3~+、CD4~+的百分率、CD4~+/CD8~+比值、NK細(xì)胞活性均升高,且外周血CD8~+的百分率減低。 結(jié)論(1)OSAHS兒童可能存在細(xì)胞免疫功能的下降,經(jīng)扁桃體、腺樣體手術(shù)干預(yù)3個月后,仍處于細(xì)胞免疫功能下降狀態(tài),而OSAHS兒童術(shù)后6個月時免疫功能失衡能夠完全逆轉(zhuǎn),說明手術(shù)可以改善患兒的免疫功能,手術(shù)的遠(yuǎn)期效果得到了肯定。(2) OSAHS兒童外周血中CD3~+、CD4~+、CD8~+細(xì)胞的百分率、CD4~+/CD8~+比值及NK細(xì)胞活性與LSaO_2及AHI等反映病情的指標(biāo)存在相關(guān)性。提示LSaO_2與AHI可能是OSAHS兒童細(xì)胞免疫功能的影響因素。
[Abstract]:Objective to study the changes of T lymphocyte subsets and NK cell activity in peripheral blood of children with OSAHS before and after operation, and to evaluate the effect of operation intervention on immune function of children with OSAHS. Methods 36 children with OSAHS diagnosed by polysomnography from March 2010 to June 2010 were collected from peripheral blood samples of 24 hours before operation, tonsil, 3 months after adenoidectomy and 6 months after adenoidectomy, and 30 cases of age were selected. Sex matched healthy children excluded from related diseases as control group. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the activity of NK cells in peripheral blood were measured by flow cytometry. The monitoring results of LSaO2AHI in PSG before operation, 3 months after operation and 6 months follow up were recorded in children with OSAHS. And compared with healthy children. Results (1) compared with healthy children, the percentage of CD3 ~ + CD4 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood of children with 1 / 1 OSAHS were significantly lower than those of healthy children, while the percentage of CD8 ~ in peripheral blood increased significantly after 3 months of treatment. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ were significantly different in NK cell activity, but there was no significant difference between them before and after 6 months follow-up. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood were not significantly different from those in healthy children. The LSaO_2 in PSG of P0.05 + 4OSAHS group was significantly lower than that of healthy children before operation. However, AHI increased significantly after 3 months of treatment, LSaO_2 increased at night and AHI decreased after treatment. However, there was no significant difference in LSaO_2 and AHI between children and healthy children after 6 months follow-up. The linear correlation analysis showed that there was no significant difference in LSaO_2 and AHI between children and healthy children (P < 0.05). The linear correlation analysis showed that: before operation, there was no significant difference between the two groups. The percentage of CD3 ~ + CD4 ~ + CD8 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood after operation were linearly correlated with the changes of LSaO _ 2AHI. With the increase of nocturnal LSaO_2 percentage, the percentage of CD3 ~ + CD4 ~ and the ratio of CD4 ~ / CD8 ~ in peripheral blood increased, and the percentage of CD8 ~ was decreased. At the same time, with the decrease of AHI, the percentage of CD3 ~ + CD4 ~ in peripheral blood and the ratio of CD4 ~ / CD8 ~ in peripheral blood of children with OSAHS increased, and the percentage of CD8 ~ in peripheral blood decreased. Conclusion there may be a decrease in cellular immune function in children with OSAHS. After 3 months of intervention through tonsils and adenoids, the cellular immune function of children with OSAHS is still in a state of decline, but the imbalance of immune function in children with OSAHS can be completely reversed at 6 months after operation. The long-term effect of the operation was confirmed. The percentage of CD3 ~ + CD4 ~ + CD8 ~ cells in peripheral blood of children with OSAHS and the ratio of CD4 ~ / CD8 ~ and NK cell activity were correlated with LSaO_2, AHI and so on. It is suggested that LSaO_2 and AHI may be the influencing factors of cellular immune function in children with OSAHS.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R766

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