Effects Of IL-21,IL-23and IL-4in The Pathogenesis Of Guillain-Barre Syndrome And The Influence Of IVIG

Objective To investigate the effects of interleukin-21(IL-21), interleukin-23(IL-23) and interleukin-4(IL-4) in the pathogenesis of Guillain-Barre syndrome(GBS) of children and the correlation between the severity of GBS. And to analyze the influence of intravenous immunoglobulin(IVIG) on the serum levels of IL-21, IL-23and IL-4in GBS.Methods This was a prospective study.41pediatric patients with GBS hospitalized in our department from Jan.2005to Sep.2012were studied. According to the time of IVIG administration, patients were divided into group A and B, respectively given IVIG within7th day and8th-12th day. The controls was25healthy children. According to Hughes score, patients were divided into mild and severe groups. The serum levels of IL-21, IL-23and IL-4of all children were detected by ELISA and the serum levels of IL-21, IL-23and IL-4were also detected by ELISA after the treatment. The limb dysfunction scores of the41patients were simultaneously evaluated according to Hughes score before and after treatment.Results Before treatment, the serum levels of IL-21, IL-23and IL-4had no significant difference between group A and group B (P>0.05), while were significantly higher than those in normal control (P<0.05). After treatment, the serum levels of IL-21, IL-23in group A and group B were significantly decreased than those before treatment (P<0.05), no significant difference in IL-4levels(P>0.05).There was no significant difference in group A and group B of the serum levels of IL-21,IL-23and IL-4after treatment (P>0.05).In the severe group, the serum levels of IL-21, IL-23were significantly higher than those in the mild group before and after treatment (P<0.05), while no significant difference in IL-4levels(P>0.05). After treatment the serum levels of IL-21, IL-23were significantly decreased than those before treatment in the mild group and the severe group (P<0.05), no significant difference in IL-4levels(P>0.05). According to Hughes score, the limb dysfunction scores after treatment decreased as compared with pretreatment, but there was no significant difference between before and after treatment(P>005).Conclusions The serum levels of IL-21, IL-23were significantly increased in GBS and there was a positive correlation with the severity of disease. They played an important role in the pathogenesis of GBS. The Levels of IL-21and IL-23significantly decreased and the limb dysfunction scores also decreased after administration of IVIG, which showed that IVIG could inhibit the secretion of IL-21and IL-23, reduce cellular inflammatory response and eventually prevent the development of GBS. The serum levels of IL-4were also significantly higher in GBS, it might also involve in the process of the disease, but IL-4secretion was not obviously affected with IVIG, it might have a role in the recovery of GBS.