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轮状病毒对肠套叠患儿肠道功能及免疫水平的影响研究*
作者:王伟1 吴向铭2 李浩伟2 门立东2 赵永祥2# 
单位:1.内蒙古科技大学包头医学院 内蒙古 包头 014040 2.包头市第四医院 
关键词:轮状病毒 肠套叠 肠道功能 免疫水平 
分类号:R 725
出版年,卷(期):页码:2023,40(4):380-382
摘要:

 摘要:目的 探讨轮状病毒对肠套叠患儿肠道功能及免疫水平的影响。方法 收集包头市第四医院2020年6月—2021年10月收治的肠套叠患儿,经便轮状病毒检查结果分为轮状病毒感染组(RI组)20例和非轮状病毒感染组(NI组)40例。对比两组手术前后便分泌型免疫球蛋白A(sIgA)水平;对比两组治疗后免疫水平,包括IgA、IgM、IgG、CD3+、CD4+、CD1q;对比两组治疗后肝肾功能水平,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr);观察两组患儿肠系膜淋巴结肿大情况和复套发生率;检测两组患儿术前及术后第1、3 d的炎性指标水平,包括WBC、C反应蛋白(CRP)。结果 灌肠前RI组sIgA低于NI组,灌肠后RI组sIgA高于NI组,两组比较差异均有统计学意义(t=6.219、3.132,均P<0.05);组内比较,RI组灌肠前后sIgA比较差异有统计学意义(t=6.341,P<0.05),NI组灌肠前后sIgA比较差异无统计学意义(t=0.148,P>0.05)。治疗后RI组IgG、CD1q与NI组比较,差异均无统计学意义(t=0.432、0.634,均P>0.05);治疗后RI组IgA、IgM、CD3+、CD4+与NI组比较,差异均有统计学意义(t=3.081、2.298、5.250、2.363,均P<0.05)。RI组治疗后ALT、AST、Scr均高于NI组,两组比较差异均有统计学意义(t=4.430、2.765、2.013,均P<0.05)。RI组肠系膜淋巴结肿大和复套发生率均高于NI组,两组比较差异均有统计学意义(χ2=13.538、4.658,均P<0.05)。术前RI组WBC、CRP均高于NI组,两组比较差异均有统计学意义(t=2.290,均P<0.05);而两组术后第1、3 d的WBC均低于术前,组内比较差异均有统计学意义(F=57.016、9.749,均P<0.05)。结论 感染轮状病毒的肠套叠患儿炎症指标升高,肠系膜淋巴结肿大的发生率较高,sIgA是肠黏膜屏障的主要免疫球蛋白,感染轮状病毒后,sIgA分泌减少,可能会诱发肠套叠的发生;感染轮状病毒后,肠套叠的患儿复套率高,而且影响免疫功能及肝肾功能,故对于轮状病毒阳性的肠套叠患儿,需要加强术后各项指标的监测。

关键词:轮状病毒;肠套叠;肠道功能;免疫水平

 Abstract:Objective To explore the relationship between rotavirus and intestinal function and immune level in children with intussusceptio. Methods Children with intussusception admitted to the Fourth Hospital of Baotou from June 2020 to October 2021 were divided into rotavirus infection(RI)(n=20)and non-rotavirus infection(NI)groups(n=40)by fecal rotavirus examination. The levels of stool secretory immunoglobulin A(sIgA)before and after surgery were compared between the two groups, the immune levels in the two groups after treatment, including IgA, IgM, IgG, CD3+, CD4+, CD1q were compared. The liver and kidney function levels in the two groups after treatment, including alanine aminotransferase(ALT), glutamic oxalacetic transaminase(AST), and blood creatinine(Scr)were compared. The enlargement of mesenteric lymph nodes and the incidence of recurrence in the children of the two groups were observed. The levels of inflammatory indexes, including WBC, C-reactive protein(CRP)were measured before and on the 1st and 3rd postoperative days in both groups. Results The sIgA of the RI group was lower than that of the NI group before the enema, and the sIgA of the RI group was higher than that of the NI group after the enema, and the differences between the two groups were statistically significant(t=6.219, 3.132, all P<0.05); compared within the groups, the differences between the sIgA of the RI group before and after the enema were statistically significant (t=6.341, P<0.05), and the differences between the sIgA of the NI group before and after the enema, there was no statistically significant difference(t=0.148, P>0.05). The differences between IgG and CD1q in the RI group and NI group after treatment were not statistically significant(t=0.432, 0.634, all P>0.05); the differences between IgA, IgM, CD3+, CD4+ in the RI group and NI group after treatment were statistically significant(t=3.081, 2.298, 5.250, 2.363, all P<0.05). ALT, AST and Scr were higher in the RI group than in the NI group after treatment, and the differences were statistically significant in both groups(t=4.430, 2.765, 2.013, all P<0.05). The incidence of mesenteric lymph node enlargement and recapture were both higher in the RI group than in the NI group, and the differences were statistically significant in both groups (χ2=13.538, 4.658, all P<0.05). WBC and CRP were higher in the RI group than in the NI group before surgery, and the differences between the two groups were statistically significant(t=2.290, P<0.05); while WBC in the first and third postoperative days were lower than before surgery in both groups, and the differences between the two groups were statistically significant(F=57.016, 9.749, all P<0.05). Conclusion Children with rotavirus infection with intussusception have elevated inflammatory indexes and higher incidence of mesenteric lymph node enlargement. sIgA is the main immunoglobulin of the intestinal mucosal barrier, and after rotavirus infection.sIgA secretion is reduced, which may induce the occurrence of intussusceptionafter rotavirus infection;children with intussusception have a high recapture rate, which affects immune function, liver and kidney function.Therefore, for rotavirus-positive children with intussusception, the monitoring of postoperative indicators should be strengthened.

基金项目:
?基金项目:包头医学院自然科学类青苗计划(BYJJ-ZRQM 202014)
作者简介:
参考文献:

 1] Shin DY,Yi DY,Jo S,et al. Effect of a new lactobacillus plantarum product,LRCC5310,on clinical symptoms and virus reduction in children with rotaviral enteritis[J]. Medicine(Baltimore),2020,99(38):e22192.

[2] 曲斌.综合护理干预在小儿肠套叠治疗中的应用体会[J].中国冶金工业医学杂志,2020,37(4):433-434.
[3] Burns JW,Siadat-Pajouh M,Krishnaney AA,et al. Protective effect of rotavirus VP6-specific IgA monoclonal antibodies that lack neutralizing activity[J]. Science,1996,272(5258):104-107.
[4] 廖桂,母姣,王静,等.补锌联合消旋卡多曲治疗小儿轮状病毒性肠炎中的临床疗效及对血浆TNF-α、IL-6、IL-17水平的影响[J].现代生物医学进展,2018,18(13):2508-2511,2516.
[5] 岳朝荟.轮状病毒肠炎患儿异型淋巴细胞和免疫球蛋白水平分析[J].深圳中西医结合杂志,2021,281(4):89-90.
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