更昔洛韦治疗婴儿巨细胞病毒感染前后免疫功能的 .doc

更昔洛韦对巨细胞病毒肝炎婴儿细胞因子水平的影响 李明超，熊 菀 （重庆医科大学附属儿童医院，重庆 400013） 摘 要：目的 通过检测更昔洛韦治疗前后巨细胞病毒 cytomegalovims，CMV 肝炎婴儿血清IL-2、IL-8、IL-10、IFN-γ水平的变化，了解更昔洛韦在CMV肝炎发生、发展和恢复过程中对上述细胞因子的影响，探讨其对机体免疫功能的影响及作用机制。方法 采用ELISA法检测72例患儿血清CMV-IgM ，定量PCR检测血CMV DNA ，两者均为阳性，而ALT正常者作为观察组1；伴有ALT异常者作为观察组2；正常健康体检婴儿作为健康对照组。采用ELISA法检测3组血清IL-2、IL-10、IL-8、IFN-γ水平，并对观察组2采用更昔洛韦治疗后再检测上述细胞因子水平。结果 （1）与健康对照组比较，观察组1患儿血清IL-8、IL-10均显著升高（t 3.74，9.56 P 0.01 ，IL-2显著降低（t 5. 87 P 0.01 。（2）观察组2患儿血清IFN-γ与健康对照组比较显著升高（t 5.93 P 0.01 ，而观察组1患儿与健康对照组儿童血清IFN-γ比较无统计学差异（t 0.86 P＞0.05 。（3）观察组2患儿经更昔洛韦治疗后，血清IL-2水平较观察组1显著增高（t 3.41 P 0.01 ，而血清IL-8、IL-10、IFN-γ水平则恢复至接近建康对照组儿童水平，两者比较均无显著性差异（t 0.74,0.36,0.54 P＞0.05 。（4）观察组2用药前后自身对照比较，血清IL-8、IL-10、IFN-γ水平显著下降（t 6.52,7.24,14.23 P 0.01 ，血清IL-2水平显著升高（t 5.78 P 0.01 。（5）观察组2 IFN-γ水平与ALT值有较好的正相关性 r 0.76 P 0.01 。结论 （1）CMV感染后导致患儿血清中相关细胞因子分泌紊乱，提示机体出现Thl/ Th2细胞平衡失调；（2）更昔洛韦除了具有抑制和清除病毒的功能外，还具有改善机体免疫功能的作用，规范使用下安全、可靠、不良反应小。 关键词：巨细胞病毒感染；更昔洛韦；细胞因子；婴儿 中图法分类号：R373.2 文献标识码：A The effect of cytokine level in infants with cytomegalovirus infection after cured with ganciclovir LI Ming-chao,Xiong Wan Children’s Hospital of Chongqing Medical University , Chongqing, 400013 ,China Abstract： Objective To investigate the changes of serum cytokines IL-2、IL-8、IL-10、IFN-γ before and after cured with ganciclovirexplore the underlying mechanisms of ganciclovir and the immunological changes in the development and progression of cytomegalvirus CMV infection. Methods CMV-IgM in serum were measured by enzyme-linked immunosorbent assay ELISA ;CMV DNA in blood were measured by quantitative PCR testing.CMV-IgM + and CMV DNA + were as observed group 1. With abnormality of ALT, as observed group 2. The healthy children were taked as healthy control group, the level of serum IL-2、IL-10、IL-8、IFN-γ of each group were examined by ELISA,and CMV masculine hepatitis group were cured with ganciclovirthen the cell factor level of them were examined again.Results 1.The levels of IL-8、IL-10 in group 1 were signifi