T细胞亚群分布对过敏性紫癜患儿复发风险的预测价值

The Predictive Value of the Distribution of T Cell Subsets in Children with Allergic Purpura

目的探讨T细胞亚群分布对过敏性紫癜(HSP)患儿复发风险的预测价值。方法选择2018年6月至2019年5月于我院确诊HSP的患儿112例,所有患儿于入院时均采用流式细胞技术检测外周血中T淋巴细胞亚群(CD3+、CD4+、CD8+)分布情况,并收集患儿入院时临床资料及实验室检查资料。而后按照《诸福棠实用儿科学》中对于儿童HSP的治疗方案进行系统治疗,患儿症状消失,实验室检查结果恢复正常水平后停药。对患儿进行为期6月的随访,统计随访期间患儿病情复发情况。根据复发情况分组后采用Logistic回归分析判定T淋巴细胞亚群分布与患儿复发之间的关系,而后通过构建ROC曲线分析T淋巴细胞亚群分布相关指标对HSP患儿复发的预测价值。结果截止2019年12月31日,共计5例患儿达到脱落标准,最终纳入单因素分析患儿112例,其中随访期间47例患儿达到HSP复发标准,复发率为37.5%。最终分组为未复发(n=70)和复发(n=42)。单因素分析结果显示,HSP复发患儿肾脏受累占比、病情重度占比、CD3+及CD8+均显著高于未复发患儿,而CD4+则显著低于未复发患儿(P<0.05)。肾脏受累(OR=8.025,95%CI=2.082~30.931)、血液中CD4+/CD8+(OR=10.734,95%CI:2.823~40.816)及CD8+(OR=1.846,95%CI:1.064~3.201)为影响HSP复发的危险因素,T淋巴细胞亚型中CD4+(OR=0.909,95%CI:0.837~0.989)为影响HSP复发的保护因素(P<0.05)。CD4+、CD8+及CD4+/CD8+对HSP患儿疾病复发预测的均有一定价值(P<0.001)。CD4+/CD8+预测特异性及阳性预测值显著高于其他两种方式(P<0.05)。结论T淋巴细胞亚群分布与HSP患儿复发之间存在有显著的相关性,其中CD4+/CD8+对HSP患儿复发具有较好的预测价值。

Objective To investigate the predictive value of the distribution of T cell subsets in children with allergic purpura(HSP).Methods 112 children with HSP diagnosed in our hospital from June,2018 to May,2019 were selected for the study.All children were admitted to the hospital by using flow cytometry to detect the distribution of T-lymphocyte subsets(CD3+,CD4+,CD8+)in peripheral blood,and to we collected clinical and laboratory data from admission.Then according to the“Zhu Futang Practical Pediatrics”,the treatment was applied.After the treatment,the symptoms of these children disappeared,the laboratory test results returned to normal levels and then discontinued.These children were followed up for 6 months and the recurrence of the children’s condition during the follow-up duration was counted.After grouping according to relapse,logistic regression analysis was used to determine the relationship between the distribution of T lymphocyte subsets and the recurrence of children,and then the ROC curve was drawn to analyze the predictive value of T lymphocyte subset distribution related indicators for the recurrence of HSP children.Results As of December 31,2019,a total of 5 children had reached the shedding standard,and 112 children were finally included in the univariate analysis.Among them,47 patients reached the HSP recurrence standard during the follow-up duration,with a recurrence rate of 37.5%.The final grouping had not relapsed(n=70)and relapsed(n=42).Univariate analysis showed that the proportion of kidney involvement,severity of disease,CD3+and CD8+in children with HSP recurrence were significantly higher than those in non-relapsed children,while CD4+T was significantly lower than those in non-relapsed children(P<0.05).Renal involvement(OR=8.025,95%CI:2.082-30.931),CD4+/CD8+(OR=10.734,95%CI:2.823-40.816)and CD8+(OR=1.846,95%CI:1.064-3.201)were risk factors affecting the recurrence of HSP.Among the T lymphocyte subtypes,CD4+(OR=0.909,95%CI:0.837-0.989)was the protective factor affecting the recurrence of HSP(P<0.05).CD4+,CD8+and CD4+/CD8+had certain values in predicting the recurrence of disease in children with HSP(P<0.001).The specificity and positive predictive value of CD4+/CD8+were significantly higher than those of the other two methods(P<0.05).Conclusion There is a significant correlation between the distribution of T lymphocyte subsets and the recurrence of HSP children.Among them,CD4+/CD8+has a good predictive value for the recurrence of HSP children.