Th1/Th2淋巴细胞亚群类细胞因子在紫癜性肾炎患儿中的测定和意义

Determination and significance of Th1/Th2 lymphocyte subsets cytokines in children with henoch-schonlein purpura nephritis

目的:探讨紫癜性肾炎(HSPN)患儿Th1/Th2淋巴细胞亚群类细胞因子水平的变化差异以及其临床意义,为临床治疗提供实验依据。方法:采集中山市人民医院普通儿科收治住院的50例HSPN患儿病例资料,时间起始在2015年1月至2018年12月。50例患儿(研究组)按临床分型,其中孤立性血尿型12例,孤立性蛋白尿型17例,血尿蛋白尿型15例,肾病综合征型6例;共有38例行肾穿刺活检术,病理分型参照2000年中华儿肾学组病理分级标准,其中IIa型14例,IIb型17例,IIIa型7例,另有12例家属拒绝行肾活检术。选择门诊健康体检儿童30例作为对照组。检测其血清IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、IgG、IgM、IgA、IgE、C3、C4浓度,比较它们的变化差异,并做统计相关性分析。结果:(1)研究组IL-4(4.072±1.706)pg/ml显著高于对照组(2.206±0.738)pg/ml( P<0.05),研究组TNF-α(5.168±1.446)pg/ml显著高于对照组(2.117±0.539)pg/ml( P<0.05),研究组IL-10(5.368±1.561)pg/ml高于对照组(3.531±1.258)pg/ml( P<0.05),研究组IgE(445.040±86.827)IU/ml高于对照组(83.100±22.973)IU/ml( P<0.05)。(2)TNF-α与IgE呈正相关( r=0.964, P<0.05)。(3)TNF-α/ IL-10比值>0.747 6时,对于HSPN有预测价值(曲线下面积为0.787,灵敏度为72%,特异度为80%)。 结论:1.Th1/Th2型细胞因子变化导致的免疫功能紊乱与HSPN患儿发病相关;Th1/Th2型细胞因子在发病过程中存在不平衡分泌表达,IL-4、IL-10和TNF-α可能为关键因子。2.观察细胞因子的分泌规律应比单纯分析细胞失衡更加有意义。3.TNF-α与IgE相关,间接证明HSP及HSPN或与Ⅰ型血管变态反应有关。4.TNF-α/ IL-10比值>0.747 6时,提示紫癜性肾炎的损伤因子和保护因子比例失衡,该比值可作为预警紫癜性肾炎危险因素的一个参考指标。

Objective To study the changes and their clinical significance of the levels of Th1/Th2 lymphocyte subsets cytokines in children with henoch-schonlein purpura nephritis(HSPN).Methods 50 cases of children with HSPN hospitalized in department of pediatrics of Zhongshan People's Hospital from January 2015 to December 2018 were collected(study group),including 12 cases of isolated hematuria type,17 cases of isolated proteinuria type,15 cases of hematuria and proteinuria type,6 cases of nephrotic syndrome type according to clinical classification.A total of 38 children underwent renal biopsy,with the pathological grading standards of Chinese children renal committee in 2000 as the reference,including 14 cases of type IIa,17 cases of type IIb,7cases of type IIIa;the family members of other 12 cases refused to renal biopsy.30 children from health checkup outpatient were chosen as control group.The serum concentration of IL-2,IL-4,IL-6,IL-10,TNF-α,IFN-γ,IgG,IgM,IgA,IgE,C3,and C4 were detected,the differences were compared,and the statistical correlation analysis was made.Results(1)The level of IL-4 of the study group was significantly higher than that of the control group[(4.072±1.706)pg/ml vs.(2.206±0.738)pg/ml](P<0.05),the level of TNF-αof the study group was significantly higher than that of the control group[(5.168±1.446)pg/ml vs.(2.117±0.539)pg/ml](P<0.05),the level of IL-10 of the study group was significantly higher than that of the control group[(5.368±1.561)pg/ml vs.(3.531±1.258)pg/ml](P<0.05),the level of IgE of the study group was significantly higher than that of the control group[(445.040±86.827)IU/ml vs.(83.100±22.973)IU/ml](P<0.05).(2)TNF-αwas positively correlated with IgE(r=0.964,P<0.05).(3)The TNF-α/IL-10 ratio>0.7476,had predictive value for HSPN(the area under the curve was 0.787,the sensitivity was 72%,the specificity was 80%).Conclusion 1.Immune dysfunction caused by the changes of Th1/Th2 type cytokines is related to the HSPN disease in children;there are imbalanced secretion expression of Th1/Th2 type cytokines in the course of illness,IL-4,IL-10,and TNF-αmay as the key factors.2.Observation on the secretion rule of cytokines should be more meaningful than simple analysis of cell imbalance.3.TNF-αis positively correlated with IgE,which indirectly proves HSP and HSPN may be related to typeⅠallergic vascular response.4.TNF-α/IL-10 ratio>0.7476 prompts imbalanced ratio of damage factor and protection factor of HSPN,the ratio can be used as reference index warning risk factors of HSPN.