过敏性紫癜患儿25-羟维生素D的表达及与免疫功能的关系  

Expression of serum 25-hydroxyvitamin D and its relationship with immune function in children with Henoch-Sch?nlein purpura

作　　者：郑荣浩[1] 刘冬蕾 黄力[1] 朱松柏[1] 贵琳[1] 吴晓林[1] ZHENG Rong-hao;LIU Dong-lei;HUANG Li;ZHU Song-bai;GUI Lin;WU Xiao-lin(Department of Nephrology,Rheumatism and Immunology,Maternal and Child Health Hospital of Hubei Province,Hubei Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院儿童肾脏风湿免疫科,湖北武汉430070

出　　处：《中国妇幼健康研究》2018年第11期1392-1396,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨血清25-羟维生素D[25-(OH)D]在过敏性紫癜(HSP)患儿中的表达情况,并分析其与免疫指标之间的相关性。方法选取2016年8月至2018年1月在湖北省妇幼保健院住院的139例HSP患儿及同期门诊体检正常的80例儿童分别作为HSP组及健康对照组,采用液相色谱-串联质谱法检测HSP组患儿及健康对照组儿童的血清25-(OH)D水平,并使用流式细胞术和免疫比浊法分别检测HSP组患儿的细胞及体液免疫水平。HSP组根据是否合并肾脏受累又分为非紫癜性肾炎组(NHSPN组)108例及紫癜性肾炎组(HSPN组)31例,使用二元Logistic回归分析血清25-(OH)D影响HSP患儿发病及并发肾脏受累的风险,并采用多元线性回归分析血清25-(OH)D与各免疫指标的相关性。结果 HSP组血清25-(OH)D水平明显低于健康对照组(t=-9.103,P<0.001),HSPN组血清25-(OH)D水平分别低于NHSPN组和健康对照组,差异均具有统计学意义(t值分别为2.857、-8.955,均P<0.05)。HSP组血清25-(OH)D水平与IgA及CD8^+T水平呈负相关(β=-0.418,t=-5.538,P<0.01;β=-0.231,t=-3.064,P=0.003)。健康对照组儿童血清25-(OH)D水平每降低1ng/mL,其发生HSP的风险将增加至原来的1.103倍(OR=1.103,95%CI:1.073～1.133,P<0.001),而HSP组患儿25-(OH)D水平每升高1ng/mL,其发生肾脏受累的风险降低至原来的0.939倍(OR=0.939,95%CI:0.897～0.983,P=0.007)。结论血清25-(OH)D在HSP患儿中的水平明显降低,且与细胞免疫及体液免疫功能均相关,可能参与了HSP的免疫发病过程;恢复血清25-(OH)D的水平可能会降低HSP并发肾脏受累的风险。Objective To investigate the expression of serum 25-hydroxyvitamin D [25（OH）D]in children with Henoch-Sch？nlein purpura（HSP）and analyze its correlation with immune parameters.Methods Liquid chromatography-tandem mass spectrometry was performed to test serum 25（OH）D levels in 139 children with HSP in HSP group and 80 healthy children in healthy control group admitted in Maternal and Child Health Hospital of Hubei Province from August 2016 to January 2018.Flow cytometry and immunonephelometric assay were used to test cellular levels and humoral immune function in children with HSP.The children with HSP were divided into NHSPN group（108 cases）and HSPN group（31 cases）according to whether or not they had renal involvement.Binary Logistic regression was performed to analyze the risk of HSP in children and renal involvement in children with HSP caused by 25（OH）D,and multiple linear regression was used to analyze the correlation between serum 25（OH）D and various immune parameters.Results The serum 25（OH）D level in HSP group was significantly lower than that in the healthy control group（t=-9.103,P0.001）and that in HSPN group was also lower than that in NHSPN group and the healthy control group with statistical significance（t value was 2.857 and-8.955,respectively,both P〈0.05）.There were negative correlations among the levels of serum 25（OH）D and CD8~＋T and IgA in HSP group（β=-0.418,t=-5.538,P0.001;β=-0.231,t=-3.064,P=0.003）.When the level of serum 25（OH）D decreased by 1 ng/mL in health children,the risk of HSP would increase to 1.013 times（OR=1.103,95%CI：1.073-1.133,P0.001）.When its level increased by 1 ng/mL in children with HSP,the risk of renal involvement would decrease to 0.939 times（OR=0.939,95%CI：0.897-0.983,P =0.007）.Conclusion The level of serum 25（OH）D in children with HSP is significantly reduced,and it is related to cellular immunity and humoral immunity function,so 25（OH）D may be involved in the immunopathogenesis of HSP.Restoring

关 键 词：25-羟维生素D 过敏性紫癜 紫癜性肾炎 免疫球蛋白A 细胞免疫 

分 类 号：R725.9[医药卫生—儿科]