颉雅苹?童志杰?樊慧峰?卢秉泰?陈容珊

【摘要】目的 研究CD4+CD25+叉頭样转录因子3阳性（Foxp3+）调节性T淋巴细胞（Treg）及相关细胞因子、总IgE（TIgE）、特异性IgE（sIgE）在有或无特应征反复喘息幼儿外周血介导的免疫应答差异，为幼儿喘息性疾病的发展预测及治疗提供新思路。方法 选择反复喘息幼儿45例，分为特应征组22例和非特应征组23例，另选20名健康幼儿作为健康对照组，分别检测3组幼儿外周静脉血Treg计数和血清IL-10、IL-4、IL-5、IL-13、IFN-γ、TGF-β及TIgE、sIgE水平。结果 特应征组吸入及食入变应原sIgE阳性率高于非特应征组（P均< 0.05）。特应征组外周血Treg计数和血清IL-10、IFN-γ水平低于非特应征组，而非特应征组低于对照组（P均< 0.05）;特应征组血清IL-4、IL-5、IL-13、TIgE水平高于非特应征组，而非特应征组高于对照组（P均< 0.05）。特应征组及非特应征组血清TGF-β水平比较差异无统计学意义（P > 0.05），均高于对照组（P均< 0.05）。反复喘息患儿外周血Treg计数与血清IL-10水平呈正相关（r = 0.875，P < 0.001）。结论 Treg、IL-10、IL-4、IL-5、IL-13、TGF-β及IFN-γ可能参与了幼儿喘息，在过敏性疾病中发挥免疫调节作用。反复喘息幼儿外周血Treg计数与血清IL-10水平呈正相关。Treg与IL-10未来可能作为幼儿反复喘息早期预测及治疗的新靶点。

【关键词】喘息;儿童;T淋巴细胞;白介素-10;免疫球蛋白E;免疫调节

Study of levels of CD4+ CD25+ Foxp3+ regulatory T cells， IL-10 and IgE in peripheral blood of children with repeated wheezing Xie Yaping， Tong Zhijie， Fan Huifeng， Lu Bingtai， Chen Rongshan. Department of Respiratory， Guangzhou Women and Childrens Medical Center， Guangzhou 510623， China

Corresponding author， Tong Zhijie， E-mail： tongzhijie1972@ 163. com

【Abstract】Objective To investigate the differences in the peripheral blood-mediated immune responses of CD4+CD25+Foxp3+ regulatory T cells （Treg） and related cytokines， total IgE （TIgE） and specific IgE （sIgE） in children with or without atopic physique and repeated wheezing， aiming to provide novel ideas for the development prediction and treatment of infantile wheezing diseases. Methods Forty-five infants with repeated wheezing were selected and divided into the atopic （n = 22） and non-atopic groups （n = 23）， and 20 healthy children were allocated into the normal control group. The counts of Treg， the levels of IL-10， IL-4， IL-5， IL-13， IFN-γ， TGF-β and TIgE and sIgE in the peripheral blood were quantitatively detected. Results The positive rate of sIgE for inhalation and ingestion allergens in the atopic group was significantly higher than that in the non-atopic group （both P < 0.05）. The peripheral blood Treg cell counts， IL-10 and IFN-γ levels in the atopic group were significantly lower compared with those in the non-atopic group， whereas the values in the non-atopic group were remarkably lower than those in the control group （all P < 0.05）. The serum levels of IL-4， IL-5， IL-13 and TIgE in the atopic group were significantly higher than those in the non-atopic group， whereas the levels in the non-atopic group were considerably higher than those in the control group （all P < 0.05）. The serum level TGF-β did not significantly differ between the atopic and non-atopic groups （P > 0.05）， which were significantly higher than that in the control group （both P < 0.05）. In children with repeated wheezing， the proportion of peripheral blood Treg cells was positively correlated with serum IL-10 levels （r = 0.875， P < 0.001）. Conclusions Peripheral blood Treg cells， IL-10， IL-4， IL-5， IL-13， TGF-β and IFN-γ may be involved with the infantile wheezing， and play an immunomodulatory role in allergic diseases. The counts of peripheral blood Treg cells is positively correlated with the serum IL-10 levels in infants with repeated wheezing. Treg and IL-10 may serve as novel targets for early prediction and treatment of repeated wheezing in the future.

三、反复喘息患儿外周血Treg计数与血清IL-10水平的相关性分析

反复喘息患儿外周血Treg计数与血清IL-10水平呈正相关（r = 0.875，P < 0.001），见图2。

讨论

幼儿反复喘息是一种异质性疾病，与烟草暴露、母亲患哮喘、呼吸道病毒感染、特应征体质等因素有关[7-8]。临床观察显示，具有特应征的反复喘息幼儿较不具有特应征幼儿更易发展至哮喘，但其发病机制尚不明确，随着过敏性疾病发病率的增加，如何早期客观评价幼儿反复喘息的性质并评估其预后，已成为当前儿科领域的重要挑战。

现有研究显示，支气管哮喘是辅助性T淋巴细胞2型（Th2）介导的以气道高反应、可逆的气流受阻、气道嗜酸性粒细胞浸润、气道黏液高分泌及血清高IgE为特征的气道慢性炎症性疾病[9]。一般认为，哮喘患者体内存在Th1/Th2失衡，Th1细胞受到抑制，Th2细胞异常活化，Th1细胞分泌的细胞因子IFN-γ和Th2细胞分泌的细胞因子IL-4、IL-5、IL-13参与了过敏性哮喘[9]。……