Objective: To investigate the immunological mechanism of prednisone in the treatment of infantile spasm (IS) by evaluating the immune function of IS children before and after treatment.
Methods: Thirty children with IS were enrolled as IS group. Thirty healthy infants who underwent physical examination were enrolled as healthy control group. Fasting venous blood was collected for both groups before and after prednisone treatment. Chemiluminescence was used to measure serum levels of interleukin-1B (IL-1B), interleukin-2R (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). Immunoturbidimetric assay was used to measure serum levels of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG). Flow cytometry was used to measure the percentages of T lymphocyte subsets (CD3+, CD4+, and CD8+). The clinical outcome and electroencephalographic findings were evaluated for all IS children after prednisone treatment.
Results: The IS group had significantly higher serum levels of IL-2R, IL-8, and TNF-α than the healthy control group before treatment (P<0.05). The mean number of daily ictal clusters was positively correlated with the levels of IL-2R, IL-8, and TNF-α in IS children, the mean number of total daily seizures was positively correlated with IL-8 level, and any two indices out of IL-2R, IL-8, and TNF-α were positively correlated with each other (P<0.05). Among the 30 IS children treated with prednisone, 19 achieved seizure control; electroencephalography showed that 18 children achieved complete remission of hyperarrhythmia. After treatment, the IS group had significant reductions in the numbers of daily ictal clusters and total daily seizures, significant improvement in developmental quotient (P<0.05), and significant reductions in serum levels of IL-2R, L-8, and TNF-α, the percentage of CD4+ T lymphocytes, and CD4+/CD8+ ratio (P<0.05), as well as a significant increase in the percentage of CD8+ T lymphocytes (P<0.05).
Conclusions: IS children have immune dysfunction. Prednisone can control seizures in IS children, possibly by regulating and improving immune dysfunction.
目的: 通过检测泼尼松治疗婴儿痉挛症（IS）患儿前后的免疫功能，探讨泼尼松治疗IS的免疫机制。
方法: 选取30例诊断为IS的患儿为IS组，30例行健康体检婴幼儿为健康对照组。采集IS组患儿经泼尼松治疗前后和健康对照组婴幼儿的空腹静脉血，采用化学发光法检测血清IL-1B、IL-2R、IL-6、IL-8、TNF-α水平；免疫比浊法检测血清免疫球蛋白IgA、IgM、IgG水平；流式细胞术检测T细胞亚群（CD3+、CD4+、CD8+）比例。泼尼松治疗后对所有IS患儿进行临床疗效和脑电图评估。
结果: 治疗前IS组血清IL-2R、IL-8、TNF-α水平高于健康对照组（P < 0.05）。IS患儿平均每日发作串数分别与IL-2R、IL-8、TNF-α水平呈正相关，平均每日发作总次数与IL-8水平呈正相关，且IL-2R、IL-8、TNF-α水平两两间也呈正相关（P < 0.05）。30例IS患儿经泼尼松治疗后，19例发作控制，18例脑电图高度失律完全缓解。治疗后IS患儿每日发作串数及每日发作总次数均较治疗前明显下降，DQ值较治疗前改善（P < 0.05）；血清IL-2R、IL-8、TNF-α水平，以及CD4+比例、CD4+/CD8+比值均较治疗前明显下降，CD8+比例较治疗前升高（P < 0.05）。
结论: IS患儿存在免疫功能紊乱，泼尼松能控制IS患儿痉挛发作的效果可能与其可调节及改善IS患儿免疫紊乱有关。