李杰 戴庆 亚力·亚森

[摘要] 目的 探索囊性包蟲病所致过敏性休克过程中特异性变应原与T细胞激活的关系，为临床治疗提供新思路。 方法 采集2015年1月～2017年12月在新疆医科大学第一附属医院行囊性包虫病内囊摘除术30例患者（研究组）血清，其中术中发生过敏性休克患者作为过敏性休克组（10例），未发生过敏性休克患者作为无过敏性休克组（20例）;另选同期健康体检者血样作为对照组（30名）。分析各组人群血清免疫球蛋白（Ig）E与IgG1水平，检测各组人群血清中白细胞介素（IL）-10、IL-4、IL-2与γ干扰素（IFN-γ）表达量，并进行相关性分析。结果 过敏性休克组术中IgE和IgG1表达量高于无过敏性休克组，差异有统计学意义（P < 0.05）。术后1周各组人群血清中IgE和IgG1表达量比较，差异无统计学意义（P > 0.05）。术前研究组血清IL-4与IL-10表达量高于对照组，差异有统计学意义（P < 0.05）。过敏性休克组术中血清IL-4、IL-10低于无过敏性休克组，IFN-γ、IL-2高于无过敏性休克组，差异有统计学意义（P < 0.05）。术后1周过敏性休克组血清IL-4、IL-10表达量高于无过敏性休克组和对照组，差异有统计学意义（P < 0.05）。IgE与IL-2、IFN-γ呈正相关（r = 0.96、0.68，P < 0.05），IgG1与IL-2、IFN-γ呈正相关（r = 0.60、0.79，P < 0.05）。 结论 过敏性休克发生主要是Th、Th2型细胞失衡，其中Th1型在过敏性休克中占主导作用，其激活与IgE和IgG1相关。

[关键词] 囊性包虫病;过敏性休克;Th1;Th2

[中图分类号] R532.32          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0093-04

[Abstract] Objective To explore the relationship between specific allergens and T cell activation during anaphylactic shock caused by cystic echinococcosis， and to provide new ideas for clinical treatment. Methods Serum was collected from 30 patients （research group） who were underwent cystic hydatid cystectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2017. The patients with anaphylactic shock during the operation were taken as the anaphylactic shock group （10 cases）， while patients without anaphylactic shock were taken as the non-anaphylactic shock group （20 cases）， and the blood samples of healthy examinees from the same period were selected as the control group （30 people）. The levels of serum immunoglobulin （Ig） E and IgG1 in each group were analyzed， while the expression levels of interleukin （IL）-10， IL-4， IL-2 and γ interferon （IFN-γ） in the serum of each group were detected， and correlation analysis was performed. Results The expression levels of IgE and IgG1 during the operation in the anaphylactic shock group were higher than those in the non-anaphylactic shock group， and the differences were statistically significant （P < 0.05）. There were no statistically significant differences in serum IgE and IgG1 expression levels among the groups after 1 week of operation （P > 0.05）. The expression levels of serum IL-4 and IL-10 before the operation in the study group were higher than those in the control group， and the differences were statistically significant （P < 0.05）. The serum IL-4 and IL-10 during the operation in the anaphylactic shock group were lower than those in the non-anaphylactic shock group， while the IFN-γ and IL-2 were higher than those in the non-anaphylactic shock group， and the differences were statistically significant （P < 0.05）. The serum IL-4 and IL-10 expression levels of the anaphylactic shock group were higher than those of the non-anaphylactic shock group and the control group after 1 week of operation， and the differences were statistically significant （P < 0.05）. IgE was positively correlated with IL-2 and IFN-γ （r = 0.96， 0.68， P < 0.05）， while IgG1 was positively correlated with IL-2 and IFN-γ （r = 0.60， 0.79， P < 0.05）. Conclusion As long as anaphylactic shock occurs， Th1 and Th2 type cells are imbalanced. Th1 type plays a leading role in anaphylactic shock， and its activation is related to IgE and IgG1.

[Key words] Cystic echinococcosis; Anaphylactic shock; Th1; Th2

包虫病（echinococcosis）是棘球绦虫寄生于宿主体内所导致的一种严重人畜共患病，疾病呈世界性分布[1-3]。人体感染包虫后，幼虫在人体内形成囊性包虫，导致囊性包虫病。目前，全世界约有3百万囊型包虫病（Eg）或泡型包虫病（Em）患者[4-5]，囊性包虫病所致过敏性休克（anaphylactic shock，AS）是患者死亡的重要并发症。前期研究发现[6-8]，无论术前术后，AS患者免疫球蛋白（Ig）E，IgG和IgG1均显著升高，且术前IgG和IgG1水平升高是AS重要的风险因子。同时，Th1、Th2型细胞在过敏性休克中具有相反效应，这两种细胞失衡在疾病发生过程中具有重要意义[9-10]。Th1、Th2型细胞在疾病的不同时期出现，AS发生时Th1型较Th2型发挥的作用更为明显[10-11]，但具体机制尚不明确。……