Hou An-cun, Lu Yan, Sha Li, Liu Li-ge, Shen Jing, Xu Yong
Department of Pediatrics, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China.
Zhonghua Er Ke Za Zhi. 2003 Sep;41(9):652-6.
To Study T lymphocyte subsets, including T(H1) and T(H2) cells in peripheral blood mononuclear cells (PBMC) of children with mycoplasma pneumonia, understand immunopathogenesis and explore the possibility of immunotherapy of patients with mycoplasma pneumonia.
Fresh peripheral blood samples of patients from two groups, group 1, mycoplasma pneumonia (MP) group (35 cases, 15 males and 20 females, age range 3 - 13 years, mean 9 years), and control group consisted of 28 healthy children (14 males and 14 females, age range 3 - 12 years, mean 7 years) were treated and run through the flow cytometry. The data were obtained by using Simultest IMK-Lymphocyte software and the percentage of CD(3)(+), CD(3)(+)CD(4)(+), CD(3)(+)CD(8)(+), CD(3)(-)CD(19)(+) and CD(3)(-)CD(16 + 56)(+) cells were counted. The percentage of T(H1) and T(H2) cells were gained through determination of intracellular cytokines IFN-gamma or IL-4 in CD(4)(+) cells by flow cytometry. The 35 patients with MP were hospitalized at our hospital. In addition to fever and cough, all the patents had abnormal X-ray findings and/or moist rale on auscultation of the lungs. The IgM antibody to Mycoplasma pneumoniae was positive in each patient. Immunoglobulins were measured, and PPD skin tests were performed in 30 out of the 35 patients with MP. T test and rank sum test by SPSS FOR WINDOWS 10.0 was used for statistical analysis.
The percentage of CD(3)(+) and CD(4)(+) T lymphocyte was 68.00 +/- 6.66 and 37.86 +/- 5.84, respectively, in MP group, and 63.71 +/- 7.92 and 34.54 +/- 6.23 in control group (P < 0.05). The percentage of T(H1) cells was 14.13 +/- 8.46 in patients and 20.77 +/- 6.89 in normal control group (P = 0.001). The percentage of NK cells was 15.57 +/- 12.16 and 20.39 +/- 9.64 in MP and control group (P < 0.01). The ratio of T(H1)/T(H2) in MP group was lower than that in control group (P < 0.05). However the percentage of CD(8), T(H2), B cells and CD(4)/CD(8) had no difference between the MP and control groups. The levels of IgG, IgA, and IgM in serum were normal in most of patients except for a few patients who had elevated IgA and IgM levels. The PPD skin tests were negative in 30 out of 35 patients.
In this study a higher percentage of CD(3)(+), CD(4)(+) T lymphocyte and lower percentage of T(H1), NK cells in PBMC of patients with mycoplasma pneumonia were found. The ratio of T(H1) and T(H2) cells in patients was also lower. None of thirty patients had positive PPD skin tests. Unbalanced cell-mediated immunity with a tendency toward T(H2) existed in patients with MP. Therefore, immunomodulators may be useful in treatment of mycoplasma pneumonia.
研究支原体肺炎患儿外周血单个核细胞（PBMC）中T淋巴细胞亚群，包括辅助性T细胞1（Th1）和辅助性T细胞2（Th2），了解其免疫发病机制并探讨支原体肺炎患者免疫治疗的可能性。
两组患者的新鲜外周血样本，第1组为支原体肺炎（MP）组（35例，男15例，女20例，年龄范围3 - 13岁，平均9岁），对照组由28名健康儿童组成（男14例，女14例，年龄范围3 - 12岁，平均7岁），对样本进行处理并通过流式细胞术检测。使用Simultest IMK - Lymphocyte软件获取数据，计数CD(3)(+)、CD(3)(+)CD(4)(+)、CD(3)(+)CD(8)(+)、CD(3)(-)CD(19)(+)和CD(3)(-)CD(16 + 56)(+)细胞的百分比。通过流式细胞术测定CD(4)(+)细胞内细胞因子干扰素 - γ（IFN - γ）或白细胞介素 - 4（IL - 4）来获得Th1和Th2细胞的百分比。35例MP患者在我院住院治疗。除发热和咳嗽外，所有患者X线检查均有异常表现和/或肺部听诊有湿啰音。每位患者肺炎支原体IgM抗体均为阳性。检测免疫球蛋白，并对35例MP患者中的30例进行结核菌素纯蛋白衍生物（PPD）皮肤试验。使用SPSS FOR WINDOWS 10.0软件进行t检验和秩和检验进行统计分析。
MP组CD(3)(+)和CD(4)(+)T淋巴细胞百分比分别为68.00±6.66和37.86±5.84，对照组分别为63.71±7.92和34.54±6.23（P < 0.05）。患者组Th1细胞百分比为14.13±8.46，正常对照组为20.77±6.89（P = 0.001）。MP组和对照组自然杀伤细胞（NK细胞）百分比分别为15.57±12.16和20.39±9.64（P < 0.01）。MP组Th1/Th2比值低于对照组（P < 0.05）。然而，MP组和对照组之间CD(8)、Th2、B细胞以及CD(4)/CD(8)的百分比无差异。大多数患者血清中免疫球蛋白G（IgG）、免疫球蛋白A（IgA）和免疫球蛋白M（IgM）水平正常，少数患者IgA和IgM水平升高。35例患者中30例PPD皮肤试验为阴性。
本研究发现支原体肺炎患者PBMC中CD(3)(+)、CD(4)(+)T淋巴细胞百分比升高，Th1、NK细胞百分比降低。患者Th1和Th2细胞的比值也降低。30例患者PPD皮肤试验均为阴性。MP患者存在细胞介导免疫失衡且有向Th2偏移的趋势。因此，免疫调节剂可能对支原体肺炎的治疗有用。
