过敏性紫癜肾炎合并肺炎支原体感染患儿免疫功能变化

A study on immune function of children with Henoch-Schonlein purpura nephritis complicated by Mycoplasma infection

目的通过检测合并肺炎支原体(MP)感染的过敏性紫癜肾炎(HSPN)患儿免疫功能水平探讨MP感染HSPN的免疫学发病机制。方法 182例急性期HSP患儿根据MP-IgM检测分组HSP-MP^+68例、HSP-MP^-114例,HSP-MP^+组根据有无肾脏损害分组HSPN-MP^+13例、NHSPN-MP^+55例,同期25例健康儿童为对照组。通过流式细胞仪免疫荧光法检测外周血免疫细胞(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、CD19^+、CD16^+CD56^+),速率散射比浊法检测免疫球蛋白(IgG、IgM、IgA)和补体(C_3、C_4)血清水平。结果 HSP-MP^+组和HSP-MP^-组CD3^+、CD4^+、CD4^+/CD8^+较对照组下降且有统计学意义(P<0.05),CD8^+、CD19^+水平上升且有统计学意义(P<0.05);HSP-MP^-组较HSP-MP^+组CD4^+/CD8^+、CD19^+下降CD16^+CD56^+、上升有统计学意义(P<0.05)。HSPN-MP^+组和NHSPN-MP^+组CD3^+、CD4^+、CD4^+/CD8^+水平较对照组下降且有统计学意义(P<0.05),CD19^+水平上升且有统计学意义(P<0.05);HSPN-MP^+组和NHSPN-MP^+组间比较无差异(P>0.05)。HSP-MP^+组和HSP-MP^-组IgA较对照组上升且有统计学意义(P<0.05),C3下降且有统计学意义(P<0.05),HSP-MP^+组较HSP-MP^-组IgM升高,C_3下降更加显著(P<0.05)。HSPN-MP^+组和NHSPN-MP^+组IgM、IgA较对照组上升且有统计学意义(P<0.05),C_3下降有统计学意义(P<0.05),C_4三组间无差异(P>0.05)。HSPN-MP^+组和NHSPN-MP^+组间比较除IgM水平升高有统计学意义(P<0.05),余比较无差异。结论 HSP患者均存在免疫功能紊乱,过敏性紫癜合并肺炎支原体感染主要表现为体液免疫紊乱,其中IgM水平的升高可作为MP感染合并HSPN的高危因素之一。

Objective To explore the correlation between MP infection and HSPN in immunity in the children with HSPN by observing the changes of the immune function. Methods 68 MP- IgM positive HSP children（ HSP- MP^＋ group）,114 MP- IgM negative HSP children（ HSP- MP- group）,25 healthy children（ control group） were enrolled,the HSP-MP＋ group were divided into the group of HSPN（ HSPN-MP＋ group）and the group of NHSPN（ NHSPN-MP＋ group） according to whether the patients combined with kidney injury.The activity of CD3^＋,CD4^＋,CD8^＋,CD4^＋/ CD8^＋,CD19^＋ and CD16^＋CD56^＋ were detected by flow cytometry.The plasma immunoglobulin IgG,IgM and IgA,as well as complements C3 and C4 were detected by automatic biochemistry analyzer. Results Compared with the controls, the levels of CD3^＋,CD4^＋ and CD4^＋/ CD8^＋ significantly decreased in HSP group（ P〈0. 05）,while CD8^＋ and CD19^＋ increased（ P〈0. 05）. The levels of CD4^＋/ CD8^＋,CD16^＋CD56^＋ and CD19^＋ of HSP-MP- group showed significant different when compared with the HSP-MP＋group（ P〈0.05）.The CD3^＋,CD4^＋ and CD4^＋/ CD8^＋ level of the HSPN-MP^＋ group were lower than the NHSPN-MP ＋ group,however,the level of CD19^＋ was higher than NHSPN- MP^＋ group,the differences were statistically significant. Compared with the controls,the levels of IgA significantly increased in HSP group（ P〈0.05）,C3 level significantly decreased（ P〈0.05）. The levels of IgA、C3 and C4 of the HSP-MP^＋ group showed significant different when compared with the HSP-MP- group. Compared with the controls,the levels of IgM and IgA significantly increased in HSPN-MP^＋ and NHSPN-MP^＋ group（ P〈0. 05）,C3 level decreased（ P〈0. 05）.The level of IgM significantly increased in the HSPN- MP^＋ when compared with the NHSPN- MP^＋ group.Conclusions The abnormal changes of immune function exist in children with HSP and the main performance was the confused humoral immunity. The increased IgM may contribute to the development of HSPN complicated by Mycoplasma pneumoniae infection.