抽动障碍患儿T淋巴细胞亚群、血清神经元特异性烯醇化酶水平及意义

doi:10.12372/jcp.2022.21e1478

摘要/Abstract

摘要：

目的探讨抽动障碍（TD）患儿T淋巴细胞亚群及血清神经元特异性烯醇化酶（NSE）水平与抽动症状严重程度、临床分型的关联性,分析其临床意义。方法收集2020年6月至2021年6月就诊的TD患儿的临床资料,根据耶鲁综合抽动严重程度量表（YGTSS）将其分为轻度TD组和中重度TD组,根据临床分型标准将TD组分为短暂性抽动障碍（TTD）组、慢性运动或发声性抽动障碍（CTD）组及Tourette综合征（TS）组。与同期行常规体检健康儿童的T淋巴细胞亚群及NSE水平进行比较。结果纳入180例TD患儿（TD组）,男141例、女39例,年龄（7.3±2.3）岁;对照组150例,男115例、女35例,年龄（7.4±2.2）岁。TD组CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺均低于对照组,NSE水平高于对照组,差异有统计学意义（P<0.05）。轻度TD组（n=73）、中重度TD组（n=107）和对照组之间CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NSE水平差异均有统计学意义（P<0.05）。中重度TD组CD3⁺低于轻度TD组及对照组,NSE高于轻度TD组及对照组,差异均有统计学意义（P<0.05）。NSE水平与TD严重程度呈显著正相关（r=0.82,P<0.001）。TTD组（n=115）、CTD组（n=42）、TS组（n=23）与对照组之间CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NSE水平差异均有统计学意义（P<0.05）。TTD组、CTD组、TS组的CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺均低于对照组,NSE均高于对照组,差异有统计学意义（P均<0.05）。结论 TD患儿存在T淋巴细胞免疫紊乱;其NSE水平升高,升高程度与疾病严重程度有关,与疾病临床分型无关。

关键词: 抽动障碍, 细胞免疫, 神经元特异性烯醇化酶

Abstract:

Objective To investigate the association of T lymphocyte subsets and serum neuron-specific enolase (NSE) levels with the severity of tic symptoms and clinical types in Tic disorders (TD) children, and to analyze its clinical significance. Methods Clinical data of children with TD who attended one neurology clinic from June 2020 to June 2021 were collected. According to the Yale Global Tic Severity Scale (YGTSS), the children were divided into the mild TD group and the moderate to severe TD group. According to the DSM-V clinical classification standard, the TD group is divided into transient tic disorder group (TTD group), chronic exercise or vocal tic disorder group (CTD group), Tourette syndrome group (TS group). T lymphocyte subsets and NSE levels were compared between TD children and healthy children who underwent routine physical examination at the same time. Results A total of 180 TD children (TD group) were enrolled, including 141 boys and 39 girls, and the mean age was (7.3±2.3) years. There were 150 children (115 boys and 35 girls) in the control group, and the mean age was (7.4±2.2 years). The levels of CD3⁺, CD3⁺CD4⁺ and CD4⁺/CD8⁺ in TD group were lower than those in the control group, and the NSE level in TD group was higher than that in the control group, and the difference was statistically significant (P<0.001). The differences in CD3⁺, CD3⁺CD4⁺, CD4⁺/CD8⁺ and NSE levels between the mild TD group (n=73), the moderate to severe TD group (n=107) and the control group were statistically significant (P<0.05). The CD3⁺ level in the moderate to severe TD group was lower than that in the mild TD group and the control group, the NSE level in the moderate to severe TD group was higher than that in the mild TD group and the control group, and the difference was statistically significant (P<0.05). The NSE levels were significantly positively correlated with TD severity (r=0.82, P<0.001). The differences in CD3⁺, CD3⁺CD4⁺, CD4⁺/CD8⁺ and NSE levels between the TTD group (n=115), CTD group (n=42), TS group (n=23) and the control group were statistically significant (P<0.05). The levels of CD3⁺, CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the TTD group, CTD group and TS group were lower than those in the control group, the NSE level was higher than that in the control group, and the differences were statistically significant (P<0.05). Conclusions T lymphocyte immunity disorder was found in TD children. The level of NSE increased, and the degree of elevation was related to the severity of the disease, but not to the clinical classification of the disease.

Key words: tic disorders, cellular immunity, neuron-specific enolase

李蔚沁, 张子璐, 秦卓, 张利亚, 过玥. 抽动障碍患儿T淋巴细胞亚群、血清神经元特异性烯醇化酶水平及意义[J]. 临床儿科杂志, 2022, 40(6): 456-460.

LI Weiqin, ZHANG Zilu, QIN Zhuo, ZHANG Liya, GUO Yue. T lymphocyte subsets and serum neuron-specific enolase levels in children with tic disorder and their clinical significance[J]. Journal of Clinical Pediatrics, 2022, 40(6): 456-460.

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项目	对照组(n=150)	TD组(n=180)	统计量	P
CD3⁺（x±s）/%	70.8±4.2	67.4±5.5	t=6.24	<0.001
CD3⁺CD4⁺（x±s）/%	43.1±8.0	34.5±6.2	t=10.84	<0.001
CD3⁺CD8⁺[M(P₂₅~P₇₅)]/%	24.8(19.2~30.8)	25.6(21.9~29.2)	Z=1.31	0.191
CD4⁺[M(P₂₅~P₇₅)]/CD8⁺	1.7(1.2~2.5)	1.3(1.0~1.7)	Z=5.26	<0.001
NSE[M(P₂₅~P₇₅)]/ng·mL^-1	11.8(11.1~12.3)	20.8(19.2~22.6)	Z=15.64	<0.001

项目	对照组(n=150)	轻度TD组(n=73)	中重度TD组(n=107)	统计量	P
CD3⁺（x±s）/%	70.8±4.2	68.4±5.6¹⁾	66.7±5.4¹⁾²⁾	F=22.32	<0.001
CD3⁺CD4⁺（x±s）/%	43.1±8.0	35.6±6.2¹⁾	33.8±6.2¹⁾	F=60.44	<0.001
CD3⁺CD8⁺[M(P₂₅~P₇₅)]/%	24.8(19.2~30.8)	26.9(22.4~29.3)	24.7(21.5~29.1)	H=2.44	0.296
CD4⁺[M(P₂₅~P₇₅)]/CD8⁺	1.7(1.2~2.5)	1.3(1.1~1.8)¹⁾	1.3(1.0~1.7)¹⁾	H=27.74	<0.001
NSE[M(P₂₅~P₇₅)]/ng·mL^-1	11.8(11.1~12.3)	19.0(18.1~19.6)¹⁾	22.1(21.0~23.7)¹⁾²⁾	H=281.81	<0.001

项目	TTD组(n=115)	CTD组(n=42)	TS组(n=23)	对照组(n=150)	统计量	P
CD3⁺（x±s）/%	68.2±5.3¹⁾	66.2±5.4¹⁾²⁾	65.6±6.0¹⁾²⁾	70.8±4.2	F=16.24	<0.001
CD3⁺CD4⁺（x±s）/%	35.4±5.7¹⁾	33.4±6.7¹⁾	32.4±7.5¹⁾	43.1±8.0	F=41.21	<0.001
CD3⁺CD8⁺[M(P₂₅~P₇₅)]/%	24.9(21.6~29.2)	26.2(22.7~29.1)	25.6(22.4~29.8)	24.8(19.2~30.8)	H=1.93	0.586
CD4⁺[M(P₂₅~P₇₅)]/CD8⁺	1.4(1.1~1.8)¹⁾	1.3(1.0~1.6)¹⁾	1.3(1.0~1.6)¹⁾	1.7(1.2~2.5)	H=29.98	<0.001
NSE[M(P₂₅~P₇₅)]/ng·mL^-1	20.8(19.0~22.4)¹⁾	20.9(19.5~23.5)¹⁾	20.1(19.1~22.6)¹⁾	11.8(11.1~12.3)	H=245.11	<0.001