【作者】 卫重侠；

【导师】 席卫平；

【作者基本信息】 山西医科大学 ， 儿科学， 2010， 硕士

【摘要】 目的：了解山西省部分3-6岁儿童反复呼吸道感染的影响因素和T淋巴细胞亚群及NK细胞的变化,为防治反复呼吸道感染发生,提高儿童的生活质量,避免临床上过度或不当的治疗,以及制定科学、合理和经济的防治措施而提供理论依据。方法：严格按照入选标准和剔除标准收集来山西省妇幼保健院儿保科就诊的3-6岁儿童230例,其中：病例组118例,对照组112例。采用病例对照研究。对研究对象通过问卷调查,收集儿童的一般人口学特征、营养状况、父母育儿方式、家庭环境等情况。用流式细胞仪对病例组和对照组分别进行T细胞亚群、NK细胞的检测。使用SPSS13.0统计软件建立数据库并进行分析：t检验、χ2检验对两组进行均衡性检验；应用非条件Logistic回归对反复呼吸道感染的影响因素进行分析；对两组T细胞亚群进行Wilcoxon秩和检验,NK细胞进行t’检验。结果：1、病例组和对照组性别(χ2=1.584,P=0.208),年龄(t=1.650,P=0.100),体重(t=0.341,P=0.733),身高(t=0.124,P=0.902)差异均无统计学意义(P>0.05)。2、反复呼吸道感染的影响因素：①危险因素包括：每周摄入蔬菜1-3次(OR=5.195,95%CI(1.193,22.624)),入托(OR=5.642,95%CI(1.149,27.702)),入托前有反复呼吸道感染病史(OR=8.129,95%CI(2.725,24.256)),每日户外活动不足2小时(OR=5.291,95%CI(1.576,17.763))；②保护因素包括：父亲教育程度在高中以上(OR=0.134,95%CI(0.034,0.527)),每周摄入水果4-6次(OR=0.231,95%CI(0.069,0.775)),年使用抗生素低于3次[OR=0.028,95%CI(0.003,0.303))3、对T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)进行两独立样本的Wilcoxon秩和检验,结果表明：CD3+(Z=-1.588,P=0.112),CD4+(Z=-0.541,P=0.588),CD8+(Z=-0.733,P=0.463),CD4+/CD8+(Z=-0.315,P=0.753)病例组和对照组差异均无统计学意义。4、对NK细胞(CD3-CD16+CD56+)进行t’检验(t’=2.779,P=0.006,95%CI(0.674,4.003)),病例组低于对照组,差别有统计学意义(P<0.05)。结论：1、对3-6岁反复呼吸道感染儿童的多因素分析结果提示,以下因素可能对儿童反复呼吸道感染有保护作用。①平衡膳食,保证动物性食物、蔬菜和水果的摄入；②合理安排户外活动时间；③提高家长文化程度(尤其是父亲)；④托幼机构应该加强卫生保健工作,做好在园(所)儿童的晨、午、晚间检查,发现疾病及时隔离,尽量减少或避免交叉感染的发生⑤对患呼吸道感染儿童应及时治疗,合理用药,避免滥用抗生素。2、淋巴细胞检测结果表明：①在反复呼吸道感染的儿童中,T细胞亚群没有变化,提示在预防用药时,应该合理、慎重使用免疫调节剂,以免不当治疗和增加患者的经济负担；②在临床上,对于反复呼吸道感染儿童检测NK细胞是有意义的。更多还原

【Abstract】 Objective To investigate the impact factors on recurrent upper respiratory tract infections(RRTIs) and change of T lymphocytes、NK cell in children aged 3 to 6 years in Shanxi. For enhancing the quality of children life,avoiding unreasonable therapy in order to explore new method for taking prevention measures.Methods 230 Children aged 3 to 6 years were collected with strict criterion choice and abandoned. The case group had 118 samples, the control group had 112 samples. case-control study was used. one self-administered questionnaire was used to know children’general information, nutrition, the way parents breed children and family environment. The expression of CD3, CD4, CD8 on T cells; CD16 CD56 on NK cells from peripheral blood was evaluated by a flow cytometry method. SPSS13.0 software were used for data analyses:the equilibrium test compared by t-test andχ2 analysis; the impact factors on RRTIs were analyzed by the Logistic regression. The subset of T lymphocytes compared by Wilcoxon rank sum test of two independent samples, NK cell was compared by t’-test.Results1、There were no significant difference in sex(χ2=1.584,P=0.208), age(t=1.650, P=0.100), weight(t=0.341,P=0.733), height(t=0.124,P=0.902) between case group and control group(P>0.05). which indicated that the sample can represent the population.2、The impact factors on RRTIs:①The risk factors:1 to 3 times intake of vegetables every week (OR=5.195,95%CI(1.193,22.624)), kindergartens (OR=5.642,95%CI (1.149,27.702)),RRTIs disease history (OR=8.129,95%CI (2.725,24.256)), and less than outdoor exercise of 2 hours (OR=5.291,95%CI (1.576,17.763))②The protective factors:the level of father education (OR=0.134,95%CI(0.034,0.527)), taking 4 to 6 times fruits every week (OR=0.231,95%CI(0.069,0.775)), lower 3 frequencies using of antibiotics in one year (OR=0.028,95%CI(0.003,0.303))3、The subset of T lymphocytes compared by Wilcoxon rank sum test of two independent samples, we concluded that there were no statistically significant difference for all comparisons. CD3+(Z=-1.588, P=0.112), CD4+(Z=-0.541, P=0.588), CD8+(Z=-0.733, P=0.463), CD4+/CD8+(Z=-0.315, P=0.753).4、There were statistically significant difference in NK cell between two groups. (t’=2.779,P=0.006,95%CI(0.674,4.003))Conclusions 1、From the conclude of the impact factors:①Keeping intake of vegetables,fruits, meat.②Reasonably arrange time of outdoor exercise everyday may decrease the frequencies ofRRTIs.③It is positive affect for recurrent respiratory tract infections to the higher level of parents’education, especially father.④Kindergartens should enhance the work of health care. Do examine in morning、noon and evening. Finding the disease’children should be isolation in time. To decrease or avoid the cross-infection.⑤Respiratory tract infection in children should be therapied in time, and reasonably use the drug, to avoid abusing antibiotic.2、From the conclude of the lymphocytes:①For children on RRTIs, T lymphocytes were not change. In prevention, we should reasonable use immunomodulation, to avoid generating a great economic impact.②In the clinic, flow cytometric analysis of the subset of NK cell is a useful means for RRTIs.更多还原