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通过免疫特征预测流感患者的不良预后

By LabMedica International staff writers
Posted on 18 Mar 2014
研究人员发现了一种标志性的免疫应答,它也许能帮助医生确定哪些刚诊断的流感患者最可能出现严重的症状且预后不良。

儿童感染流感后有出现并发症的风险,但与疾病严重程度相关的免疫因素尚不得而知,有人提出感染部位的先天细胞免疫应答与疾病预后有关。

美国田纳西州孟菲斯市圣犹达儿童研究医院的科学家开展了一项队列观察研究,从84名自然感染流感者的外周部位和黏膜部位纵向采样,其中一些是婴儿。用鼻灌洗液和血液量化细胞反应、病毒载量和细胞因子,并与临床严重程度建立关联。当病人因流感症状而寻医时开始采样,在第3、7、10和28天重复采样。科研人员在测量鼻和鼻窦内流感病毒水平的同时测量了42个细胞因子和血液循环中的流感病毒抗体。

检验结果显示,儿童和成人一样成功地消灭了病毒,无论病毒是什么亚型。实际上,从病人血液、鼻和鼻窦内的细胞因子水平来看,儿童产生了比成人更强烈的炎症反应。针对年龄和病毒载量做调整后,研究开始时的先天免疫特征如果是鼻灌洗液中单细胞趋化蛋白3、干扰素(IFN)-α2和血浆中白细胞介素10 (IL-10)的水平升高,则预示着病情将加重。血浆中IL-10、单细胞趋化蛋白3和IL-6水平的升高预示要住院。

该研究的论文发表于2014年2月15日的《美国呼吸道与重症监护医疗》(American Journal of Respiratory and Critical Care Medicine)杂志。资深作者Christine Oshansky博士说:“儿童呼吸道内的先天免疫应答比成人更强这一事实出人意料。此前使用不同指标的研究报道儿童产生的免疫应答更弱。在这项研究中,过度活跃的免疫应答随年龄而减弱,但它也许有助于解释为什么婴幼儿更有可能出现严重症状。正常的基因变异也许在先天免疫应答中发挥一定作用。”

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