吉兰-巴雷综合征患者免疫球蛋白治疗前后T淋巴细胞亚群的变化及其意义

目的 研究吉兰-巴雷综合征(GBS)患者应用静脉大剂量注射免疫球蛋白(IVIG)治疗前后T淋巴细胞亚群的变化,并进一步探讨IVIG治疗GBS的可能机制.方法 选择31例临床确诊的GBS患者,以治疗前后作为自身对照,根据治疗效果评定为效优组和效劣组,应用流式细胞分析仪检测GBS患者外周血中T淋巴细胞亚群相对计数.结果 ①GBS患者急性期治疗后CD8+T细胞(28.77%±11.02%)和CD4+CD29+T细胞百分率(56.71%±12.44%)较治疗前(分别为31.84%±12.35%、62.40%±12.72%)显著降低(t=2.995、3.919,P＜0.05),CD4+/CD8+值和CD4+CD45RA+T细胞百分率较治疗前显著升高(t=2.368、3.860,P＜0.05),但治疗前后CD3+T细胞和CD4+T细胞百分率差异无统计学意义.②效优组CD8+T细胞和CD4+CD29+T细胞百分率较治疗前显著降低(t=2.144、3.343,P＜0.05),CD4+/CD8+值和CD4+CD45RA+T细胞百分率较治疗前显著升高(t=2.159、3.277,P＜0.05),效劣组T淋巴细胞亚群分布在治疗前后未发生明显变化.③在本组资料中,IVIG治疗急性期GBS 2周内的显效率为61.29%(19/31),无死亡病例.结论 急性期GBS患者在IVIG治疗前后发生了不同程度T淋巴细胞亚群分布的改变,为探讨GBS的发病机制及IVIG治疗GBS的机制提供了免疫学基础;IVIG治疗效果好,能够有效抑制病情进展,促进神经功能恢复.

T-lymphocyte subsets in patients with Guillain-Barré syndrome change after intravenous immunoglobulin treatment and its significance

Objective To study the changes of the T-lymphocyte subsets in patients with Guillain-Barré syndrome(GBS)before and after intravenous immunoglobulin treatment(IVIG),and to explore the possible mechanism of the IVIG curing GBS further.Methods Chose 31 cases of clinically confirmed GBS were enrolled and compared before and after the treatment.According to the effect of the therapy,31 cases of the total were sub-divided into effective and ineffective groups.Relative counting of peripheral blood T-lymphocyte subsets was preformed with flow cytometry.Results ①The percentage of CD8+ T and CD4+CD29+ T cell was significantly lower(CD8+T:28.77%±11.02% vs 31.84%±12.35%,CD4+CD29+T:56.71%±12.44% vs 62.40%±12.72%,t=2.995,3.919,P＜0.05)after therapy,while the rate of CD4+/CD8+T and the percentage of CD4+CD45RA+T cell increased notably(t=2.368,3.860,P＜0.05);but there was no notable difference in the percentage of CD3+T and CD4+T cell.②The percentage of CD8+T and CD4+CD29+ T cell was significantly lower(t=2.144,3.343,P＜0.05)after the treatment,while the rate of CD4+/CD8+T and the percentage of CD4+CD45RA+T cell increased notably(t=2.159,3.277,P＜0.05)in the good curative effect group,but there was no change in the bad curative effect group.③61.29%(19/31)of the patients significantly improved by IVIG,and there was no death case.Conclusions T-lymphocyte subsets change in a varing degree after IVIG treatment in acute GBS patients,which lays an immunological foundation for the further study of pathogenesis and mechanism of IVIG curing GBS;effective on GBS,IVIG can actively suppress pathogenetic condition and promote the recovery of nrevous function.