Abstract: Objective To explore the change of immune function and the effect of adrenocorticotropic hormone (ACTH) on lymphocyte subsets and serum immunoglobulin levels in children with infantile spasm. Methods Forty cases of infantile spasm treated in department of pediatrics of our hospital from October 2014 to October 2019 were selected as case group, 40 healthy children as normal control group. ACTH was administered for 4 weeks for patients. Flow cytometry was used to measure the percentages of lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD20⁺). Immunoturbidimetric assay was used to measure serum levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) before and after 4 weeks of treatment, and the results were compared with those of the control group. Results The count of CD8⁺ T cells in patients before treatment was significantly lower than that in the control group [(34.36±3.48)% vs.(32.33±3.08)%] (P<0.01); the ratio of CD4⁺ /CD8⁺ T cell was significantly higher than that in the control group (P<0.05). There were no statistically significant differences in the count of CD3⁺ T cells, CD4⁺ T cells, CD19⁺ B cells, CD20⁺ B cells, and the levels of immunoglobulin between patients before treatment and the control group (all P>0.05). After treatment with ACTH, the count of CD8⁺ T cells in patients [(36.34±4.18)%] was obviously higher than that before treatment (P<0.01); the count of CD4⁺ T cells was obviously lower than that before treatment [(41.08±4.66)% vs.(45.54±5.04)%] (P<0.01); the ratio of CD4⁺ /CD8⁺ T cell was obviously lower than that before treatment [(1.11±0.27) vs.(1.45±0.37)] (P<0.01). There were no statistically significant differences in the count of CD3⁺ T cells, CD19⁺ B cells, CD20⁺ B cells, and the levels of immunoglobulin in patients before and after 4 weeks of treatment (all P>0.05). Conclusion Children with infantile spasm have immunological alterations, and ACTH can regulate the immune function in children and control the development of the disease.

Key words: Infantile spasm, Lymphocyte subsets, Immunoglobulin, Adrenocorticotropic hormone

摘要： 目的 探讨婴儿痉挛症患儿免疫功能变化及促肾上腺皮质激素(ACTH)对淋巴细胞亚群和免疫球蛋白的影响。方法 选取2014年10月至2019年10月本院儿科住院治疗的40例婴儿痉挛症患儿作为病例组,40例健康儿童为对照组。病例组给予ACTH治疗4周,治疗前及治疗4周后分别静脉抽血。流式细胞术检测CD3⁺ T淋巴细胞、CD4⁺ T淋巴细胞、CD8⁺ T淋巴细胞、CD19⁺ B淋巴细胞、CD20⁺ B淋巴细胞和CD4⁺/CD8⁺。免疫比浊法检测血清免疫球蛋白IgA、IgM、IgG水平,并与对照组进行比较。结果 婴儿痉挛症患儿治疗前CD8⁺ T淋巴细胞为(34.36±3.48)%,低于对照组的(32.33±3.08)%,差异有统计学意义(P<0.01);CD4⁺/CD8⁺值较对照组增高(P<0.05)。婴儿痉挛症患儿治疗前CD3⁺ T淋巴细胞水平、CD4⁺ T淋巴细胞水平、CD19⁺ B淋巴细胞水平及CD20⁺ B淋巴细胞水平与对照组比较,差异均无统计学意义(均P>0.05)。婴儿痉挛症患儿治疗前免疫球蛋白水平与对照组比较差异均无统计学意义(均P>0.05)。婴儿痉挛症患儿治疗后CD8⁺ T淋巴细胞为(36.34±4.18)%,较治疗前明显升高(P<0.01)。CD4⁺ T淋巴细胞治疗后为(41.08±4.66)%,治疗前为(45.54±5.04)%,明显降低(P<0.01)。CD4⁺/CD8⁺值治疗后为(1.11±0.27),治疗前为(1.45±0.37),明显降低(P<0.01)。婴儿痉挛症患儿治疗前后CD3⁺ T淋巴细胞水平、CD19⁺ B淋巴细胞水平及CD20⁺ B淋巴细胞水平比较差异均无统计学意义(均P>0.05)。婴儿痉挛症患儿治疗前后免疫球蛋白水平比较差异均无统计学意义(均P>0.05)。结论 婴儿痉挛症患儿存在免疫功能紊乱,ACTH可调节婴儿痉挛症患儿免疫功能,为婴儿痉挛的免疫治疗提供了理论依据。

关键词: 婴儿痉挛症, 淋巴细胞亚群, 免疫球蛋白, 促肾上腺皮质激素