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目的：探讨细胞、体液免疫应答以及相关的细胞因子在EV71 相关手足口病合并肺水肿中的作用。方法：将90 例经鉴定为 EV71 感染患儿分为手足口病合并肺水肿组38 例，手足口病无并发症组52 例，并设查体健康对照组28 例。ELISA 法检测90 例 EV71 感染引起的手足口病患儿血清IL-6、IL-10、TNF-α 及IFN-γ 含量；采用流式细胞仪对血液中CD3+T 、CD4+ 及CD8+T 细胞百分比进行检测；采用免疫比浊法对90 例EV71 感染引起的手足口病患儿血清免疫球蛋白（IgG、IgA 及IgM）及补体C3、C4 含量进行检测。结果：手足口病合并肺水肿组患儿血清IL-6、IL-10 及IFN-γ 含量明显升高，同时伴随CD4+ 及CD8+T 细胞百分比下降；手足口病合并肺水肿组，无并发症组及健康对照组患儿血清IgM 分别为1.85±0.73，1.46±0.790 和0.88±0.39，三组之间差别具有统计学意义（F=14.967，P<0.05）。而IgG 与IgA 在三组之间无明显变化（X2=5.535, P>0.05; F=1.988, P>0.05）；手足口病患儿血清C3 及C4 含量均明显低于健康对照组（F=46.079;62.794, P<0.05）。结论：由IL-10 及IFN-γ的异常释放而引起的广泛的中枢及外周神经系统炎症反应和T 淋巴细胞衰竭是引起EV71 合并肺水肿病程进展的重要原因；在EV71 感染后引发的手足口病进程中存在IgM 的大量释放，且伴随补体C3、C4 的消耗。

英文摘要:

Objective: To determine the effect of cellullar immunologic response, humoral reactions and cytokine in children with pulmonary edema after enterovirus-71-related hand, foot and mouth disease. Methods: Children who confirmed infected by enterovirus-71 were divided into two groups: 38 patients with pulmonary edema and 52 patients without complications. And 28 patients were considered as health control group. Serum IL-6, IL-10, TNF-α and IFN-γwere detected by ELISA. Flow cytometry was used to analyze the number of CD4+ and CD8+T cell in leukomonocyte suspension. And serum immunoglobin and complement (C3, C4) were detected by immunoturbidimetry. Results: A significant elevation of plasma interleukin (IL)-10 and interferon (IFN)-γlevels observed in patients with PE. Patients with PE also had lower circulating CD4+T cells and CD8+T cells. Serum IgM levels were 1.85±0.73 and 1.46±0.79 respectively in children in groups with complications and without complications, which significantly higher than that (0.88±0.39) in patients in controls (F=6.287, P<0.05). However, The IgG and IgA levels have no significant changes among the three groups (X2 = 5.535, P>0.05; F =1.988, P>0.05). Compared with patients in health control group, patients who experienced enterovirus-71 had decreasing C3 levels. So were serum levels of C4 (F = 46.079; 62.794, P <0.05).Conclusion: An extensive central and peripheral nervous system inflammatory response with abnormal IL-10, and IFN-γcytokine production and T lymphocyte decreasing appears to be responsible for the pathogenesis of EV71-associated PE. There have excessive immunoglobin production of IgM with decreasing C3 and C4 in patients with PE.

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