GPI-80表达动态变化与过敏性紫癜患儿病情相关性研究

The Dynamic Change of GPI-80 in Childhood Anaphylactoid Purpura

目的分析中性粒细胞表面GPI-80表达的动态变化与过敏性紫癜患儿病情变化及预后的关系。方法根据临床表现,把过敏性紫癜分为单纯皮肤型、混合型(皮肤+关节+消化道出血症状)、紫癜肾炎型,每组各20例。对每组患者分别于发病期和缓解期运用流式细胞仪检测中性粒细胞表面的GPI-80表达,比较发病期和缓解期及不同组间GPI-80表达的差异,并与正常人对照组相比较。同时对20例紫癜肾炎患儿做了肾组织活检,以比较不同病理类型之间的GPI-80表达的差异。结果过敏性紫癜患儿(各型)中性粒细胞表面的GPI-80分子表达均显著高于正常人对照组(P均<0.001)。混合型及紫癜肾炎型患儿其GPI-80又显著高于单纯皮肤型(t=21.39,22.9,P<0.001),且受累脏器越多,GPI-80表达越高。但混合型与紫癜肾炎型之间差异无显著性(t=1.84,P>0.05)。20例不同病理类型的紫癜肾炎型患儿,GPI-80表达差异无显著性。对现有随访的42例患儿(单纯皮肤型10例、混合型15例、紫癜肾炎型17例)于好转出院时(平均住院13.5d)及出院2周时的血标本进行GPI-80表达的检测。发现平均住院13.5d后,GPI-80水平较入院时略有下降(从93.26%±7.89%降到91.37%±6.9%),但差异无显著性。出院2周后大部分患者(35/42例)GPI-80水平明显下降(平均38.44%±7.8%),仍有部分患儿(7/42例)

Objective To analyze the relationship between dynamic change of GPI-80 and disease severity and prognosis of childhood anaphylactoid purpura. Methods Patients were collected and divided into three groups according to their clinical features: purpura group (purpura only), mixed group (purpura + arthritis + gastrointestinal bleeding) and nephritis group. There were 20 patients in each group. GPI-80 expression on the neutrophils was detected by flow cytometry during acute and regressive phases of the disease. GPI-80 expression was compared among different groups and different phases. Renal biopsies were performed in 20 nephritis patients. Results GPI-80 expression was significantly increased in all patient groups compared with that in the normal control (P < 0.001). Mixed and nephritis groups had higher GPI-80 expression than that of purpura group respectively (P < 0.001, P < 0.001). Moreover, the more the organs involved, the higher GPI-80 expressed. There was no significant difference of GPI-80 expression between mixed and nephritis groups (P > 0.05). No significant difference of GPI-80 expression was found among 20 nephritis patients with different pathological patterns. Forty-two patients (10 in purpura group, 15 in mixed group, and 17 in nephritis groups) were followed up and GPI-80 expression was detected at the time of discharge and 2 weeks after discharge, the results showed that GPI-80 expression was decreased from 93.26% (±7.89%) at acute phase to 91.37% (±6.9%) at regressive phase with an average interval of 13.5 days. Most of them (35/42) further decreased to 38.44% (±7.8%) in 2 weeks after discharge. GPI-80 expression remained high in 7 patients for 2 weeks after discharge and relapsed in 5 patients within 1 month after discharge. Conclusions High GPI-80 expression is related to the severity of the disease. The decrease of GPI-80 takes place later than the improvement of clinical symptoms. Children with persistently high GPI-80 expression are likely to relapse. It seems that there is no correlation between GPI-80 expression and different pathological patterns of nephritis.