通讯作者: 柳楚楚, liuchuchu0823@163.com

DOI：10.12201/bmr.202410.00032

The effect of the proportion of atypical lymphocytes on the immune system of children with infectious mononucleosis

• 摘要：目的 研究异型淋巴细胞比例对传染性单核细胞增多症(IM)患儿免疫系统的影响。方法 选取2023年5月～2024年5月我院收治的153例IM患儿作为IM组,153例健康儿童作为健康组,检测两组异型淋巴细胞比例,分析异型淋巴细胞比例与IM患儿EB病毒载量的关系。检测并比较两组免疫系统指标补体C3、C4、CD19+细胞、T淋巴细胞亚群、免疫球蛋白(Ig)A、IgG、IgM表达水平,分析异型淋巴细胞比例与免疫系统指标的关系,并根据IM患儿T淋巴细胞亚群与正常儿童的差异值评价免疫系统紊乱程度分为严重免疫紊乱组、非严重免疫紊乱组,分析严重免疫紊乱IM患儿临床特征并比较异型淋巴细胞比例差异。结果 与健康组比较,IM组异型淋巴细胞比例16.56±1.34(%) vs 1.97±0.23(%)升高(P＜0.05)。Pearson检验显示,异型淋巴细胞比例与IM患儿EB病毒载量正相关(r=0.504,P＜0.05)。与健康组比较,IM组补体C31.13±0.16(g/L) vs 1.02±0.14(g/L)、C40.31±0.04(g/L) vs 0.28±0.03(g/L)、CD8+T细胞53.24±5.98(%) vs 25.46±2.31(%)、IgA11.32±1.54(g/L) vs 8.56±1.00(g/L)、IgG1.58±0.21(g/L) vs 1.02±0.14(g/L)、IgM1.54±0.23(g/L) vs 1.21±0.14(g/L)水平升高,CD4+T细胞20.13±2.43(%) vs 37.86±4.37(%)、CD4+/CD8+0.45±0.05 vs 1.52±0.26、CD19+细胞6.23±0.89(%) vs 15.46±2.31(%)降低(P＜0.05)。与非严重免疫紊乱组患儿比较,严重免疫紊乱组患儿热程更长、更易出现咽峡炎、颈部淋巴结肿大表现,EB病毒载量、异型淋巴细胞比例更高,免疫系统指标异常更显著(P＜0.05)。在儿童IM中,异型淋巴细胞比例与补体C3、C4无关(r=0.088、0.045,P＞0.05),与CD4+细胞、CD4+/CD8+、CD19+细胞负相关(r=-0.406、-0.631、-0.397,P＜0.05),与CD8+T细胞、IgA、IgG、IgM正相关(r=0.454、0.436、0.440、0.476,P＜0.05)。异型淋巴细胞比例升高是IM患儿免疫系统紊乱程度的危险因素OR(95%CI)=5.453(3.452～10.988),P＜0.05。异型淋巴细胞比例诊断IM患儿免疫系统紊乱的AUC为0.918,95%CI为0.876～0.961,当cut off值取16.00%时获得最佳诊断效能,即灵敏度为89.97%,特异度为85.64%。结论 IM患儿存在不同程度的免疫系统紊乱现象,以特异性免疫紊乱为主,其紊乱程度与异型淋巴细胞比例升高有关,异型淋巴细胞比例可作为早期诊断IM患儿免疫紊乱程度的参考指标。

  关键词： 儿童传染性单核细胞增多症; 异型淋巴细胞比例; 细胞免疫; 体液免疫; 免疫系统紊乱

   

  Abstract: Objective To study the effect of the proportion of atypical lymphocytes on the immune system of children with infectious mononucleosis (IM). Methods 153 children with IM admitted to our hospital from May 2023 to May 2024 were selected as the IM group, and 153 healthy children were selected as the healthy group. The proportion of atypical lymphocytes in both groups was measured, and the relationship between the proportion of atypical lymphocytes and the EB virus load in IM patients was analyzed. Detect and compare the expression levels of two sets of immune system indicators complement C3, C4, CD19+cells, T lymphocyte subsets, immunoglobulin (Ig) A, IgG, IgM, Analyze the relationship between the proportion of atypical lymphocytes and immune system indicators, and evaluate the degree of immune system disorder in children with IM based on the difference between T lymphocyte subsets and normal children. Divide them into severe immune disorder group and non severe immune disorder group. Analyze the clinical characteristics of children with severe immune disorder and compare the differences in the proportion of atypical lymphocytes. Results Compared with the healthy group, the proportion of atypical lymphocytes in the IM group 16.56 ± 1.34 (%) vs 1.97 ± 0.23 (%) increased (P<0.05). Pearsons test showed a positive correlation between the proportion of atypical lymphocytes and the EB virus load in children with IM (r=0.504, P<0.05). Compared with the healthy group, the IM group had C3 1.13 ± 0.16 (g/L) vs 1.02 ± 0.14 (g/L), C4 0.31 ± 0.04 (g/L) vs 0.28 ± 0.03 (g/L), CD8+T cells 53.24 ± 5.98 (%) vs 25.46 ± 2.31 (%), IgA 11.32 ± 1.54 (g/L) vs 8.56 ± 1.00 (g/L), IgG 1.58 ± 0.21 (g/L) vs 1.02 ± 0.14 (g/L), and IgM 1.54 ± 0.23 (g/L). The levels of CD4+T cells 20.13 ± 2.43 (%) vs 37.86 ± 4.37 (%), CD4+/CD8+0.45 ± 0.05 vs 1.52 ± 0.26, and CD19+cells 6.23 ± 0.89 (%) vs 15.46 ± 2.31 (%) increased and decreased (P<0.05). Compared with children in the non severe immune disorder group, children in the severe immune disorder group have a longer fever course, are more prone to symptoms of pharyngitis and cervical lymph node enlargement, a higher EB virus load, a higher proportion of atypical lymphocytes, and more significant abnormalities in immune system indicators (P<0.05). In pediatric IM, the proportion of atypical lymphocytes is not related to complement C3 and C4 (r=0.088, 0.045, P>0.05), but negatively correlated with CD4+cells, CD4+/CD8+, and CD19+cells (r=-0.406, -0.631, -0.397, P<0.05), and positively correlated with CD8+T cells, IgA, IgG, and IgM (r=0.454, 0.436, 0.440, 0.476, P<0.05). The increased proportion of atypical lymphocytes is a risk factor for the degree of immune system disorder in children with IM OR (95% CI)=5.453 (3.452-10.988), P<0.05. The AUC for diagnosing immune system disorders in children with IM using the proportion of atypical lymphocytes is 0.918, with a 95% CI of 0.876 to 0.961. The optimal diagnostic efficacy is achieved when the cut off value is 16.00%, with a sensitivity of 89.97% and a specificity of 85.64%. Conclusion Children with IM exhibit varying degrees of immune system disorders, with specific immune disorders being the main cause. The degree of disorder is related to an increase in the proportion of atypical lymphocytes, which can serve as a reference indicator for early diagnosis of immune disorders in IM patients.

  Key words: Children with infectious mononucleosis; The proportion of atypical lymphocytes; Cellular immunity; Humoral immunity; Immune system disorders

  提交时间：2024-10-12

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  1	2024-09-14	bmr.202410.00032V1	下载

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