Tekgül H, Kütükçüler N, Cağlayan S, Tütüncüoğlu S
Department of Pediatrics, Ege University, Faculty of Medicine, Izmir.
Turk J Pediatr. 1998 Jul-Sep;40(3):357-63.
Both cell-mediated immunity and humoral factors are involved in the pathogenesis of Guillain-Barré syndrome (GBS). Intravenous immunoglobulin (IVIG) has been reported to be a practical, effective and safe treatment in childhood GBS, although the mode of action of IVIG remains uncertain. We studied pro-inflammatory cytokines (interleukin-2, interleukin-1 alpha and tumor necrosis factor-alpha) in plasma and cerebrospinal fluid (CSF) and lymphocyte subsets in peripheral blood both in the acute phase and in the recovery period in six children with GBS treated with IVIG. Flow cytometry was used to determine the subsets of lymphocytes in peripheral blood, and cytokines analyses were performed by using ELISA technique. Results were compared with a control group of 20 healthy children. A standard protocol of IVIG (400 mg/kg/day for 5 days) was administered to all the patients. Plasma interleukin-2 concentrations and the number of HLA DR+ active T cells in peripheral blood were significantly higher in the acute phase of the disease than in the recovery period and in healthy controls. There was no significant difference in the other cytokine concentrations in plasma and CSF or in the other lymphocyte subsets in peripheral blood. Our data indicate that IVIG may provide its possible therapeutic effect by acting in the cell-mediated immunity in GBS patients.
细胞介导的免疫和体液因子均参与吉兰-巴雷综合征（GBS）的发病机制。静脉注射免疫球蛋白（IVIG）已被报道为儿童GBS一种实用、有效且安全的治疗方法，尽管IVIG的作用方式仍不确定。我们研究了6例接受IVIG治疗的GBS患儿急性期和恢复期血浆及脑脊液（CSF）中的促炎细胞因子（白细胞介素-2、白细胞介素-1α和肿瘤坏死因子-α）以及外周血中的淋巴细胞亚群。采用流式细胞术测定外周血淋巴细胞亚群，并使用ELISA技术进行细胞因子分析。结果与20名健康儿童的对照组进行比较。所有患者均接受标准的IVIG治疗方案（400 mg/kg/天，共5天）。疾病急性期血浆白细胞介素-2浓度及外周血中HLA DR + 活化T细胞数量显著高于恢复期及健康对照组。血浆和CSF中其他细胞因子浓度以及外周血中其他淋巴细胞亚群无显著差异。我们的数据表明，IVIG可能通过作用于GBS患者的细胞介导免疫发挥其可能的治疗效果。
