紫癜性肾炎患儿蛋白尿、免疫病理和体液免疫的关系

Relationship of Proteinuria,Immunopathogenesis and Humoral Immunity in Children with Henoch-Schonlein Purpura Nephritis

目的探讨紫癜性肾炎(HSPN)患儿蛋白尿、免疫病理和体液免疫变化之间的关系。方法HSPN患儿47例和健康体检儿童18例均于清晨空腹抽静脉血2mL。采用全自动生化分析仪检测2组儿童血清IgG、IgA、IgM、C3、C4水平,比较HSPN患儿和健康儿童血清免疫球蛋白及补体水平差异;根据蛋白尿情况进行分组,比较不同组间血清免疫球蛋白及补体水平差异;HSPN患儿行肾穿刺活检,采用直接免疫荧光法行免疫病理检查,比较各组间IgG、IgA、IgM、C3、C4免疫荧光强度的差异。采用SPSS11.0软件进行统计学分析。结果HSPN患儿血清IgG、IgA水平明显高于健康儿童,而IgM、C3、C4水平低于健康儿童(Pa<0.05);各组HSPN患儿的血清IgA、C3、C4水平无明显差异(Pa>0.05);肾病综合征(24h尿蛋白定量>50mg/kg)范围蛋白尿组IgM明显高于无蛋白尿和少量蛋白尿组(Pa<0.05);肾病综合征范围蛋白尿组IgG明显低于无蛋白尿和少量蛋白尿组(Pa<0.05)。各组间各项免疫病理荧光强度比较无显著性差异(Pa>0.05)。结论HSPN患儿有明显的免疫功能紊乱;HSPN患儿蛋白尿水平与血清免疫球蛋白和补体水平变化无明显相关性,与肾脏免疫病理损害程度无相关性;肾脏免疫损害程度与血清免疫球蛋白和补体水平无相关性。

Objective To explore the relationship of proteinuria, immunopathogenesis and humoral immunity in children with Henoch - sehonlein purpura nephritis（HSPN）. Methods Serum IgG, IgA, Ig, M, C3 and C4 levels were detected with complete -automatic biochemistry analyzer in 47 children with HSPN and 18 heathy children,and the differences in the findings were compared among groups. The levels of IgG, IgA, IgM, C3 and C4 were compared among groups according to the count of proteinuria. The renal tissues were adopteded with immunity in the children with HSPN were taken for biospy examination, and the differences in immunopathalogy were compared among groups with immunofluoreseenee assay. Results The IgG,IgA levels in children with HSPN were higher than those of heathy children,on the contrary,the IgM,C3 and C4 levels were lower than those of heathy children（P, 〈0.05）.There were no obvious differences of the serum IgA,C3 and C4 levels in 3 groups （Pa 〉 0.05 ）, but the IgM level of the nephritic syndrome group were higher than that of other groups（ Pa 〈 0. 05 ） ,while the IgG level was lower（ Pa 〈0.05 ）. There were no obvious differences of the immunopathlogy in 3 groups in children with HSPN （Pa 〉 0.05 ）. Conclusions There is severe disturbance of immunologic function in children with HSPN. There is no connections among serum IgG, IgA, IgM, Ca and C4 levels ,proteinuria and renal immunopathlogy.