摘要
目的：了解反复腹痛患儿及家庭成员幽门螺杆菌(Helicobacter pylori,Hp)感染的情况及家庭内Hp亚型的分布,研究患儿及家庭成员外周血淋巴细胞亚群的变化,明确机体免疫功能状况,以探讨Hp致胃肠疾病的免疫学相关机制。
方法：应用免疫印迹法对11个家庭50名成员及55名志愿者进行Hp亚型检测,确定是否Hp感染,选取Hp感染阴性者作为正常对照组。利用流式细胞术检测家庭成员及正常对照组外周血淋巴细胞亚群水平。根据症状分为腹痛组和正常对照组。另外再根据症状及年龄将实验对象分为腹痛患儿组、腹痛成人组及正常对照组。
结果：1.免疫印迹法检测结果：50名家庭成员中,45名为Hp阳性Ⅰ型,占90.0%,1名为Hp阳性Ⅱ型,占2.0%,4名为Hp阴性,占8.0%。55名志愿者中,25名为Hp感染阳性Ⅰ型,30名为Hp感染阴性。11个家庭中Hp感染阳性率在性别及各级亲属之间均无差异(X2=0.007,P=0.933；X2=1.259,P=0.533)；11个家庭中Ⅰ型及Ⅱ型Hp感染阳性率在性别及各级亲属之间比较均无差异(X2=1.115,P=0.291；X2=1.453,P=0.484)。
2.淋巴细胞亚群检测结果：各组外周血淋巴细胞亚群CD3+(%)、CD19+(%)、CD4+(%)、CD8+(%)、CD16+56(%)、CD4+/CD8+分别如下：腹痛组：65.74±7.95、13.48±5.21、34.48±7.09、26.48±6.24、19.33±7.54、1.38±0.46：腹痛患儿：65.45±8.37、16.55±5.89、32.09±4.85、27.64±5.77、16.18±6.68、1.20±0.26；腹痛成人：65.83±7.94、12.51±4.65、35.23±7.56、26.11±6.41、20.31±7.61、1.43±0.50；正常对照组：69.09±7.23、12.29±9.67、34.29±6.12、31.68±6.69、19.38±7.32、1.16±0.35。腹痛组外周血CD19+(%)较正常对照组增加(X2=4.344,p=0.037),且腹痛患儿组CD19+(%)较腹痛成人组及正常对照组增加(X2=8.989,p=0.011),但后两者间比较无差异；腹痛组外周血CD8+(%)较正常对照组显著降低(t=-3.573,p=0.001),且腹痛患儿组及腹痛成人组外周血CD8+(%)较正常对照组均显著降低(F=6.574,p=0.002),但前两者间比较无差异；腹痛组外周血CD4+/CD8+比值高于正常对照组(t=2.327,p=0.023),且腹痛成人组外周血CD4+/CD8+比值高于正常对照组及腹痛患儿组(F=4.109,p=0.020),后两者间比较无差异。另外各组间比较外周血CD3+(%)、CD4+(%)、CD16+56(%)均无差异。
结论：反复腹痛患儿家庭内成员Hp感染阳性率、Ⅰ型和Ⅱ型Hp感染阳性率在性别及年龄之间无差别,大部分家庭内感染Hp菌株相似,存在家庭聚集现象。家庭内成员感染Hp致病时外周血淋巴细胞亚群存在明显异常,B细胞免疫应答及T细胞免疫应答均较活跃,机体免疫在Hp感染中发挥作用,可能与疾病的进展及不同结局有关,则需进一步研究。
Objective:To investigate the prevalence and the phenotype of Helicobacter pylori (Hp) infection in family members of children with recurrent abdominal pain. To study the peripheral blood Lymphocyte subsets in family members of children with recurrent abdominal pain, define immune function conditions, to explore immunological mechanisms of the Helicobacter pylori-related gastrointestinal diseases.
Methods:Hp immunophenotyping method was used to detect the Hp type of 50 family members and 55 volunteers, made the Hp negative ones to be control. Venous EDTA blood specimen was obtained for Lymphocyte subsets analysis by flow cytometry. Divide those people in two ways: divide into recurrent abdominal pain group and the normal control group according to symptoms; divide into children with recurrent abdominal pain, family members with recurrent abdominal pain and the normal control group according to symptoms and ages.
Results:1. The results of Hp immunophenotyping method:the prevalence of Hp I type is 90%,2.0% is Hp typeⅡ,4.0% is negative in all the 50 family members.25 ones are Hp I type and 30 are negative among 55 volunteers. There is no significant difference between children and elders group about the positive rate of Hp infection of 50 family members in gender and age level(X2=0.007, P=0.933; X2=1.259, P=0.533);There is no significant difference between children and elders group about the prevalence of HpⅠ、Ⅱtype of 50 family members in gender and age level (X2=1.115, P=0.291; X2=1.453, P=0.484).
2. The results of lymphocyte subsets:Peripheral blood lymphocyte subsets in each group CD3+(%)、CD19+(%)、CD4+(%)、CD8+(%)、CD16+56(%)、CD4+/CD8+ as follows:recurrent abdominal pain group: 65.74±7.95、3.48±5.21、34.48±7.09、26.48±6.24、19.33±7.54、1.38±0.46; children with recurrent abdominal pain:65.45±8.37、16.55±5.89、32.09±4.85、27.64±5.77、16.18±6.68、1.20±0.26; adult with recurrent abdominal pain:65.83±7.94、12.51±4.65、35.23±7.56、26.11±6.41、20.31±7.61、1.43±0.50; normal control group:69.09±7.23、12.29±9.67、34.29±6.12、31.68±6.69、19.38±7.32、1.16±0.35. Compared with the normal control group, CD19+(%) in recurrent abdominal pain group was increased(X2=4.344,p=0.037), and in children with recurrent abdominal pain was increased when compared with the other two groups (X2=8.989,p=0.011); Compared with the normal control group, CD8+(%) in recurrent abdominal pain group was significantly reduced (t=-3.573,p=0.001), so was in children group and adult group with recurrent abdominal pain (F=6.574, p=0.002), but no significantly different between those two groups; Compared with the normal control group, CD4+/CD8+ in recurrent abdominal pain group was increased (F=4.109, p=0.020), Compared with children with recurrent abdominal pain and normal control group, CD4+/CD8+ in adult recurrent abdominal pain group was increased(F=4.109,p=0.020); there was no significantly different about CD3+(%), CD4+(%), and CD16+56(%) in other groups and three groups.
Conclusion:There is no significant difference about the positive rate of Hp infection and the prevalence of HpⅠandⅡtype of family members in gender and age level. There is familial cluster phenomenon in family members suffering from recurred abdominal pain. There was cellular immunity disorder in family infection with Helicobacter pylori, B cells and T cell immune response were adaptive immune response. The phenomenon may be related with the development and outcome of helicobacter pylori-induced gastrointestinal diseases. Further research is required.
引文
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