过敏性紫癜与T淋巴细胞亚群及效应细胞因子的关系

The relationships of Henoch-Schonlein purpura to T lymphocyte subsets and effector cytokines

目的探讨过敏性紫癜(HSP)患儿T淋巴细胞亚群及效应细胞因子的变化情况,并分析其对紫癜性肾炎(HSPN)的诊断效能。方法选取2017年11月1日至2019年5月31日该院收治的HSP急性期患儿60例为研究对象,其中无肾脏受累30例(HSP组),肾脏受累30例(HSPN组)。另选取同期健康儿童30例为对照组。以ELISA法测定所有受试者外周静脉血白细胞介素(IL)-2、IL-4、IL-10、IL-17水平,以流式细胞术测定辅助性T淋巴细胞(Th细胞)亚群中Th1、Th2、Th17细胞及调节性T淋巴细胞(Treg细胞)百分比。采用受试者工作特征(ROC)曲线,分析IL-2/IL-4、Th1/Th2、IL-17/IL-10及Th17/Treg比值预测HSPN的效能。结果HSP组、HSPN组IL-2、IL-10水平、Th1、Treg细胞百分比及IL-2/IL-4、Th1/Th2比值均明显低于对照组(P<0.05),IL-4、IL-17水平、Th2、Th17细胞百分比及IL-17/IL-10、Th17/Treg比值均明显高于对照组(P<0.05),且HSP组IL-17水平、Th17细胞百分比及IL-17/IL-10、Th17/Treg比值均明显低于HSPN组(P<0.05)。ROC曲线分析表明,IL-2/IL-4、Th1/Th2、IL-17/IL-10、Th17/Treg比值预测HSPN的曲线下面积依次为0.729、0.708、0.832、0.891,最佳临界值依次为0.25、5.93、0.78、0.52。结论HSP发病机制中,Th1/Th2失衡、Th17/Treg失衡发挥着重要作用,IL-2/IL-4、Th1/Th2、IL-17/IL-10、Th17/Treg比值可作为HSP早期肾脏损伤的预测指标。

Objective To explore the changes of expression levels of T lymphocyte subsets and effector cytokines in children with Henoch-Schonlein purpura(HSP),and analyse their diagnostic efficacy for purpura nephritis(HSPN).Methods A total of 60 children with HSP at the acute stage admitted to this hospital from November 1,2017 to May 31,2019 were enrolled in the study,including 30 cases without renal involvement(the HSP group)and 30 cases with renal involvement(the HSPN group).Another 30 healthy children were selected during the same period as the control group.The expression levels of interleukin(IL)-2,IL-4,IL-10 and IL-17 in peripheral venous blood samples of all subjects were detected by ELISA,and the percentages of subpopulations of helper T lymphocytes(Th cells),including Th1,Th2 and Th17,and regulatory T lymphocytes(Treg cells)were detected by flow cytometry.The receiver operating characteristic(ROC)curve was used to analyse the predictive power of the ratios of IL-2/IL-4,Th1/Th2,IL-17/IL-10 and Th17/Treg for HSPN.Results The expression levels of IL-2,IL-10,percentages of Th1,Treg cells,and ratios of IL-2/IL-4,Th1/Th2 in the HSP group and the HSPN group were significantly lower than those in the control group(P<0.05).The expression levels of IL-4,IL-17,percentages of Th2,Th17 cells,and ratis of IL-17/IL-10,Th17/Treg in the HSP and HSPN groups were significantly higher than those in the control group(P<0.05).And the expression level of IL-17,percentage of Th17 cells,and ratios of IL-17/IL-10 and Th17/Treg in the HSP group were significantly lower than those in the HSPN group(P<0.05).ROC curve analysis showedthat the area under the ROC curve of IL-2/IL-4,Th1/Th2,IL-17/IL-10 and Th17/Treg ratios in predicting HSPN was 0.729,0.708,0.832 and 0.891,and the optimal threshold value was 0.25,5.93,0.78,0.52,respectively.Conclusion The imbalance of Th1/Th2 and Th17/Treg plays an important role in the pathogenesis of HSP,and the ratios of IL-2/IL-4,Th1/Th2,IL-17/IL-10 and Th17/Treg may be used as clinical predictors of early renal damage of HSP.