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目的探讨血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-4(interleukin-4,IL-4)和干扰素-γ(interferon-γ,IFN-γ)在肺炎链球菌(streptococcus pneumoniae,SP)患儿中的动态变化及其临床意义。方法随机选择SP患儿168例为观察组,其中≤2岁104例为A组,2~5岁42例为B组,>5岁22例为C组;同期随机选择正常健康儿童80名为对照组。测定并分析比较各组治疗前后血清TNF-α、IL-4和IFN-γ水平变化情况。计量资料两组间比较采用t检验,多组间比较采用方差分析;计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果治疗前观察组血清TNF-α、IL-4和IFN-γ明显高于对照组,差异均有统计学意义(均P<0.05);观察组血清TNF-α/IL-4比值和IFN-γ/IL-4比值明显高于对照组,差异均有统计学意义(均P<0.05)。治疗后观察组血清TNF-α、IL-4、IFN-γ、TNF-α/IL-4比值和IFN-γ/IL-4比值明显下降,分别为(9.8±6.2)、(69.1±13.4)、(20.5±5.3)pg/ml、(0.5±0.32)、(3.4±1.4),与对照组比较,差异均无统计学意义(均P>0.05)。治疗前不同年龄组患儿血清中TNF-α、IL-4和IFN-γ水平均明显高于对照组,血清TNF-α/IL-4比值和IFN-γ/IL-4比值明显高于对照组,差异均有统计学意义(均P<0.05)。年龄越小,血清TNF-α、IL-4和IFN-γ水平越高,血清TNF-α/IL-4比值和IFN-γ/IL-4比值越高。结论细胞因子分泌紊乱和网络失衡是SP的重要因素,并与患儿的年龄呈反比,且TNF-α、IL-4和IFN-γ等在其发生、发展中起着重要的调控作用。
Objective To investigate the effect of serum tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4) and interferon-γ Dynamic changes in children with streptococcus pneumoniae (SP) and its clinical significance. Methods 168 children with SP were randomly selected as the observation group, 104 cases ≤2 years old as group A, 42 cases aged from 2 to 5 years as group B, 22 cases aged> 5 years as group C; 80 normal children Control group. The changes of serum TNF-α, IL-4 and IFN-γ levels before and after treatment were measured and compared. Measurement data between the two groups using t test, multiple groups were compared using analysis of variance; count data were compared using the χ ~ 2 test, P <0.05 for the difference was statistically significant. Results The levels of serum TNF-α, IL-4 and IFN-γ in the observation group before treatment were significantly higher than those in the control group (all P <0.05) γ / IL-4 ratio was significantly higher than the control group, the differences were statistically significant (P <0.05). The ratio of serum TNF-α, IL-4, IFN-γ, TNF-α / IL-4 and IFN-γ / IL-4 in the observation group were significantly decreased after treatment (9.8 ± 6.2 vs. 69.1 ± 13.4, , (20.5 ± 5.3) pg / ml, (0.5 ± 0.32) and (3.4 ± 1.4) respectively. There was no significant difference between the two groups (all P> 0.05). The serum levels of TNF-α, IL-4 and IFN-γ in children of different age groups before treatment were significantly higher than those in the control group, and the serum TNF-α / IL-4 ratio and IFN-γ / Group, the differences were statistically significant (all P <0.05). The younger the higher the serum levels of TNF-α, IL-4 and IFN-γ, the higher the ratio of serum TNF-α / IL-4 and the ratio of IFN-γ / IL-4. Conclusions The disorder of cytokine secretion and network imbalance are important factors of SP and are inversely proportional to the age of children. TNF-α, IL-4 and IFN-γ play an important regulatory role in the occurrence and development of SP.