外周血免疫细胞、免疫球蛋白、补体及Gd-IgA1在儿童过敏性紫癜中的表达及意义

Expression and significance of peripheral blood immune cells,immunoglobulin,complement and Gd-IgA1 in children with Henoch-Schonlein purpura

目的研究外周血免疫细胞、免疫球蛋白、补体及低糖化免疫球蛋白A1(Gd-IgA1)在儿童过敏性紫癜(HSP)中的表达及意义。方法将该院2017年6月至2020年6月收治的94例HSP患儿(HSP组)及50例同龄健康儿童(健康组)纳为研究对象,根据HSP患儿肾脏损伤情况将其分为紫癜性肾炎组(HSPN组)与非紫癜性肾炎组(NHSPN组),检测并比较HSPN组、NHSPN组及健康组儿童外周血免疫细胞(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD19^(+)、CD16^(+)/CD56^(+))、免疫球蛋白(IgA、IgG、IgM)、补体(C3、C4)及血清Gd-IgA1水平,并检测3组研究对象肾功能指标,分析血清Gd-IgA1水平与肾功能指标的相关性。结果HSPN组与NHSPN组患者外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及CD16^(+)/CD56^(+)水平均较健康组显著下降(P<0.05),CD8^(+)及CD19^(+)水平较健康组显著上升(P<0.05),HSPN组与NHSPN组外周血免疫细胞水平差异均无统计学意义(P>0.05);3组IgM及补体C4水平差异无统计学意义(P>0.05),HSPN组及NHSPN组IgA、补体C3水平均显著高于健康组(P<0.05),且HSPN组补体C3水平显著高于NHSPN组(P<0.05),HSPN组IgG水平明显低于NHSPN组与健康组,NHSPN组与健康组IgG水平差异无统计学意义(P>0.05);HSPN组与NHSPN组血清Gd-IgA1水平均显著高于健康组(P<0.05),且HSPN组血清Gd-IgA1水平显著高于NHSPN组(P<0.05);比较3组肾功能相关指标发现,HSPN组肾小球滤过率(GRF)水平显著低于NHSPN组与健康组(P<0.05),血肌酐(Cr)及尿素氮(BUN)水平显著高于NHSPN组与健康组(P<0.05),NHSPN组与健康组Cr、BUN及GRF水平差异无统计学意义(P>0.05);相关分析显示,HSPN组患者血清Gd-IgA1水平与GRF水平及Cr水平呈正相关(P<0.05)。结论HSP患儿细胞免疫功能下降,体液免疫功能亢进;HSPN患儿补体C3水平及血清Gd-IgA1水平均上升,检测Gd-IgA1水平在辅助诊断HSP患儿肾脏病变中具有一定价值。

Objective To investigate the expression and significance of peripheral blood immune cells,immunoglobulin,complement and galactose-deficient immunoglobulin A1(Gd-IgA1)in children with Henoch-Schonlein purpura(HSP).Methods A total of 94 HSP children(HSP group)and 50 healthy individuals(healthy group)in our hospital from June 2017 to June 2020 were enrolled.HSP group was further divided into two subgroups,henoch-schonlein purpura nephritis(HSPN)group and the non-henoch-schonlein purpura nephritis(NHSPN)group according to the condition of renal injury.The levels of peripheral immune cells(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CD19^(+),CD16^(+)/CD56^(+)),immunoglobulin(IgA,IgG,IgM),complement(C3,C4)and serum Gd-IgA1 were detected and compared among HSPN group,NHSPN group and healthy group.Renal function related indexes were also detected,then the correlation between serum Gg-IgA1 level and renal function was analyzed.Results The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+) and CD16^(+)/CD56^(+) in peripheral blood in HSPN group and NHSPN group were significantly lower than those in healthy group(P<0.05),and the levels of CD8^(+) and CD19^(+) were significantly lower than those in healthy group(P<0.05),while the above indicators had no significant difference between two subgroups(P>0.05).The levels of IgM and complement C4 had no significant difference among three groups(P>0.05).The levels of IgA and complement C3 in HSPN group and NHSPN group were significantly higher than those in healthy group(P<0.05),and the level of complement C3 in HSPN group was significantly lower than that in NHSPN group(P<0.05).The IgG level in HSPN group was significantly higher than that in NHSPN group and healthy group,and no significant difference was found in IgG level between NHSPN group and healthy group(P>0.05).The level of serum Gd-IgA1 among three groups was the highest in HSPN group,followed by NHSPN group,and was the lowest in healthy group,with statistic differences(P<0.05).Comparison showed that the level of glomerular filtration rate(GRF)in HSPN group was significantly lower than that in NHSPN group and healthy group(P<0.05),creatinine(Cr)and urea nitrogen(BUN)levels were significantly higher than those in NHSPN group and healthy group(P<0.05),while Cr,BUN and GRF levels showed no significant difference between NHSPN group and healthy group(P>0.05).Correlation analysis indicated that serum Gd-IgA1 level of patients in HSPN group was positively correlated with GRF and Cr levels(P<0.05).Conclusion Children with HSP have decreased cellular immunity and hyperactive humoral immunity.Both complement C3 level and serum Gd-IgA1 level are increased in children with HSPN,indicating that Gd-IgA1 level is of certain value in the development of renal disease in children with HSP.