Tfh、Tfr细胞表达情况与HSP患儿肾脏受累情况的关系

The relationship between the expression of Tfh and Tfr cells and the renal involvement in HSP children

目的研究过敏性紫癜(Henoch Sch?nlein purpura,HSP)患儿外周血滤泡调节性T细胞(follicular regulatory T cells,Tfr细胞)、滤泡辅助性T细胞(follicular helper T cells,Tfh细胞)的表达情况,及其与肾脏受累的关系。方法选取我院2017年2月至2020年3月期间收治的98例HSP患儿为研究组,同时段60例健康体检儿童为对照组。根据患儿肾脏受累情况将研究组分为无肾脏累及组44例(A组)、孤立性血尿组22例(B组)以及血尿合并蛋白尿组32例(C组)。采用流式细胞仪检测入组儿童外周血Tfh、Tfr细胞比例,采用RT-PCR法检测细胞相关调控因子(Bcl-6、c-MAF、Blimp-1、PD-1)mRNA的表达,并比较4组之间的水平差异,并采用Pearson相关性分析外周血Tfh、Tfr细胞水平与血清IgA的相关性。结果 4组受试者外周血Tfh、Tfr细胞以及Tfh/Tfr比值、血清IgA水平比较差异有统计学意义,其中研究组IgA、Tfh和Tfh/Tfr比值明显高于对照组,而Tfr明显低于对照组(P<0.05)。C组Tfh水平和Tfh/Tfr比值明显高于A、B组,而Tfr水平明显低于A、B组(P<0.05)。研究组外周血CD4+CD25+Treg细胞的Blimp-1 mRNA明显低于对照组,而PD-1 mRNA明显高于对照组(P<0.05)。研究组外周血CD4+T细胞的Blimp-1 mRNA明显低于对照组,而Bcl-6、c-MAF m RNA明显高于对照组(P<0.05)。Pearson相关性分析显示,患儿Tfr细胞水平与血清IgA表达量呈负相关性(r=-0.683, P<0.001),患儿Tfh细胞水平与血清IgA表达量呈正相关性(r=0.594,P<0.001)。结论 Tfh、Tfr细胞紊乱(Tfh增加,Tfr降低)导致HSP患儿免疫功能异常活化,促进自身损抗体的分泌,从而参与HSP的发生、发展过程,Tfh/Tfr比值与患儿肾脏受累程度具有正相关性。

This study was performed to evaluate the expression of peripheral blood Tfh cells and Tfr cells in children with Henoch Sch?nlein purpura(HSP), as well as their relationship with renal involvement. Total of 98 cases of HSP children in our hospital from February 2017 to March 2020 were selected as study group, while 60 cases of healthy children in the same period were selected as control group. According to the renal involvement, the study group were divided into non renal involvement group(44 cases, group A), isolated hematuria group(22 cases,group B) and hematuria combined with albuminuria group(32 cases, group C). Flow cytometry was used to detect the proportion of Tfh and Tfr cells in the peripheral blood of the enrolled children;RT-PCR was used to detect the mRNA expression of cell-related regulatory factors(Bcl-6, c-MAF, Blimp-1, PD-1). And the correlation between Tfh/Tfr cell levels and serum IgA in peripheral blood were analyzed by Pearson correlation. Data showed that IgA,Tfh and Tfh/Tfr ratio in the 4 study groups were significantly higher than those in the control group, while Tfr was significantly lower than that in the control group(P<0.05). Tfh level and Tfh/Tfr ratio in group C were significantly higher than those in groups A and B, while Tfr level was significantly lower than that in groups A and B(P<0.05). Inperipheral blood of the study groups were significantlylower than that of the control group, while the PD-1mRNA was significantly higher than that of the control group(P<0.05). The expression of Blimp-1 mRNA inperipheral blood CD4+T cells of the study groups were significantly lower than that of the control group, while theexpression of bcl-6 and c-Maf mRNA were significantly higher than those of the control group(P<0.05).Furthermore, Pearson correlation analysis showed that the level of Tfr cells in the children were negatively correlatedwith serum IgA expression(r=-0.683, P<0.001), and the level of Tfh cells in the children was positively correlatedwith serum IgA expression(r=0.594, P<0.001). In conclusion, the disorder of Tfh and Tfr cells(Tfh increase, Tfrdecrease) leds to abnormal activation of immune function in children with HSP, and promotes the secretion ofautoantibodies, thus participates in the occurrence and development of HSP. And the ratio of Tfh/Tfr was positivelycorrelated with the degree of renal involvement.