摘要
目的分析传染性单核细胞增多症(IM)病儿EB病毒DNA(EBV DNA)载量与B淋巴细胞免疫抑制因子程序性死亡受体1(PD-1)、程序性死亡受体-1配体(PD-L1)、细胞毒性T淋巴细胞相关抗原4(CTLA-4)、T细胞免疫球蛋白和ITIM结构域蛋白(TIGIT)的相关性。方法选取2020年1月至2023年1月双鸭山市人民医院就诊120例的IM病儿作为观察组,120例体检的健康儿童作为健康组,检测PD-1、PD-L1、CTLA-4、TIGIT表达,分析在观察组、健康组中的表达差异。根据IM病儿血EBV DNA载量结果中位数,将病儿分为低EBV DNA载量组(<6.3×10^(5)copies/mL)68例,高EBV DNA载量组(≥6.3×10^(5)copies/ml)52例,比较两组临床特征、PD-1、PD-L1、CTLA-4、TIGIT表达差异,分析EBV DNA载量与PD-1、PD-L1、CTLA-4、TIGIT的相关性。结果观察组B淋巴细胞中PD-1、PD-L1、CTLA-4、TIGIT表达量分别为(5.66±0.87)%、(6.95±1.12)%、(4.34±0.58)%、(7.43±0.98)%,显著高于健康组的(0.79±0.13)%、(0.88±0.27)%、(0.43±0.08)%、(1.24±0.35)%(P<0.05);急性期IM病儿B淋巴细胞中PD-1、PD-L1、CTLA-4、TIGIT表达量分别为(6.78±1.12)%、(7.64±1.43)%、(5.85±0.83)%、(8.54±1.43)%,显著高于恢复期IM病儿的(4.72±0.68)%、(5.51±0.79)%、(3.23±0.46)%、(6.17±0.96)%(P<0.05);高EBV DNA载量组热程、发热、淋巴结肿大发生率、血液系统急性并发症发生率、白细胞计数、淋巴细胞计数(LYM)、异型淋巴细胞、淀粉样蛋白A(SAA)、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)显著高于低EBV DNA载量组(P<0.05)。在儿童IM中,EBV DNA载量与热程、白细胞计数、LYM、异型淋巴细胞、SAA、CRP、LDH、ALT、AST均呈显著正相关(P<0.05);高EBV DNA载量组B淋巴细胞中PD-1、PD-L1、CTLA-4、TIGIT表达量显著高于低EBV DNA载量组(P<0.05)。结论B淋巴细胞中免疫抑制因子PD-1、PD-L1、CTLA-4、TIGIT表达过量,与IM病儿EBV DNA载量显著相关,可用于儿童IM病情的评估。
Objective To analyze the correlation between EBV DNA load and programmed death receptor 1(PD-1),programmed death receptor 1 ligand(PD-L1),cytotoxic T lymphocyte associated antigen 4(CTLA-4),T cell immunoglobulin and ITIM domain protein(TIGIT)in children with infectious mononucleosis(IM).Methods A total of 120 IM children treated in Shuangyashan People's Hospital from January 2020 to January 2023 were selected as the observation group,and 120 healthy children who underwent physical examination were selected as the healthy group.The expressions of PD-1,PD-L1,CTLA-4 and TIGIT were detected,and the expression differences between the observation group and the healthy group were analyzed.According to the median blood EBV DNA load of children with IM,68 cases were assigned into low EBV DNA load group(<6.3×10^(5)copies/mL)and 52 cases into high EBV DNA load group(≥6.3×10^(5)copies/mL).The clinical features and expression differences in PD-1,PD-L1,CTLA-4 and TIGIT were compared between the two groups,and the correlation of EBV DNA load with PD-1,PD-L1,CTLA-4,and TIGIT were analyzed.Results The expression levels of PD-1,PD-L1,CTLA-4,and TIGIT in B lymphocytes of the observation group were(5.66±0.87)%,(6.95±1.12)%,(4.34±0.58)%,and(7.43±0.98)%,respectively,which were significantly higher than those of the healthy group[(0.790.13)%,(0.88±0.27)%,(0.43±0.08)%,(1.24±0.35)%,respectively](P<0.05).The expression levels of PD-1,PD-L1,CTLA-4,and TIGIT in B lymphocytes of IM children were(6.78±1.12)%,(7.64±1.43)%,(5.85±0.83)%,and(8.54±1.43)%,respectively,which were significantly higher than those of IM children in the recovery period[(4.72±0.68)%,(5.51±0.79)%,(3.23±0.46)%,(6.17±0.96)%,respectively](P<0.05).The high EBV DNA load group had longer duration of fever,higher incidence of fever,lymphadenopathy,acute hematological compli-cations,higher white blood cell count,lymphocyte count(LYM),atypical lymphocytes,and higher expression levels of serum amyloid A(SAA),C-reactive protein(CRP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and lactate dehydrogenase(LDH)than the low EBV DNA load group(P<0.05).In children with IM,EBV DNA load was significantly positively correlated with fever duration,white blood cell count,LYM,atypical lymphocytes,SAA,CRP,LDH,ALT,and AST(P<0.05).The expression levels of PD-1,PDL1,CTLA-4,and TIGIT in B lymphocytes of the high EBV DNA load group were significantly higher than those of the low EBV DNA load group(P<0.05).Conclusion The overexpression of immunosuppressive factors PD-1,PD-L1,CTLA-4,and TIGIT in B lymphocytes is significantly associated with EBV DNA load in children with IM,which can be used for the evaluation of IM in children.
作者
徐莉垚
戚静静
武凌智
田雪
XU Liyao;QI Jingjing;WU Lingzhi;TIAN Xue(Department of Pediatrics,Shuangyashan People's Hospital,Shuangyashan,Heilongjiang 155100,China;Department of Pediatrics,Jiamusi Maternal and Child Health Hospital,Jiamusi,Heilongjiang154000,China)
出处
《安徽医药》
2025年第4期754-758,共5页
Anhui Medical and Pharmaceutical Journal
基金
黑龙江省双鸭山市应用技术研发项目(2021YFSF06)。
