紫癜性肾炎患儿系膜区C3沉积与肾脏病理及免疫指标的相关性探讨  

The study on the correlation between C3 deposition in mesangial area and renal pathology and immune indexes in children with Henoch-Sch?nlein purpura nephritis

作　　者：李雪军 张霞[2] 丁樱[2] 代彦林 徐闪闪[1] 秦亚丹 邸佳琪 杜梦珂 胡明格 LI Xue-jun;ZHANG Xia;DING Ying;DAI Yan-lin;XU Shan-shan;QIN Ya-dan;DI Jia-qi;DU Meng-ke;HU Ming-ge(Department of Graduate,Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China;Department of Pediatrics,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学研究生处,郑州450000 [2]河南中医药大学第一附属医院儿科,郑州450000

出　　处：《现代免疫学》2021年第1期61-65,共5页Current Immunology

基　　金：国家自然科学基金面上项目(81873343);河南中医药大学特色优势学科项目(STS-ZYX-2017008)。

摘　　要：为探讨紫癜性肾炎(Henoch-Sch9nlein purpura nephritis,HSPN)患儿系膜区C3沉积与肾脏病理及免疫指标的相关性,纳入2015年1月至2017年12月河南中医药大学第一附属医院儿科肾脏病区行肾活检的HSPN患儿249例。采用微量免疫比浊法测定患儿血清IgA、IgM、IgG、C3、C4水平;采用流式细胞术测定CD3^(+)、CD4^(+)、CD8^(+)T细胞水平;采用免疫荧光法对肾组织中IgA、IgM、IgG、C3和纤维蛋白(fibrin,Fib)沉积进行评价。结果显示,根据C3沉积强度,将患儿分为A组135例(-~±,54.2%)、B组83例(+,33.3%)、C组31例(++,12.4%)。在249例患儿中,肾脏病理Ⅰ级1例(0.4%)、Ⅱa级41例(16.5%)、Ⅱb级18例(7.2%)、Ⅲa级100例(40.2%)、Ⅲb级79例(31.70%)、Ⅳ级9例(3.6%)、Ⅴ级1例(0.4%)。C3沉积强度与肾脏病理分级呈正相关(r=0.127,P=0.045)。血清补体C3水平与肾小球系膜区C3沉积程度呈负相关(r=-0.210,P=0.001)。IgA、IgM、C4、IgG水平的组间比较,差异无统计学意义(P>0.05);CD4^(+)/CD8^(+)T与C3沉积程度组间比较(A组与B组、A组与C组),差异有统计学意义(P<0.05),且大部分患儿伴有CD4^(+)/CD8^(+)T下降。血清CD3^(+)、CD4^(+)、CD8^(+)T细胞水平组间比较,差异无统计学意义(P>0.05)。这提示HSPN患儿肾脏损伤程度与肾小球系膜区C3沉积有关,C3沉积程度越高,肾脏损伤越严重,相应的血清补体C3水平也越低,反映出机体的免疫功能低下。To investigate the correlation between C3 deposition in mesangial area and renal pathology and immune indexes in children with Henoch-Sch9 nlein purpura nephritis(HSPN),249 children with HSPN who underwent renal biopsy in the pediatric kidney ward of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2015 to December 2017 were selected.The levels of IgA,IgM,IgG,C3 and C4 in the serum were measured by immunoturbidimetric assay;the levels of CD3^(+),CD4^(+),CD8^(+)T cells were measured by FCM;the deposition of IgA,IgM,IgG,C3 and fibrin(Fib)in renal tissue were evaluated by immunofluorescence.The results showed that,according to the degree of C3 deposition,the patients were assigned to group A(-~±,135 cases,54.2%),group B(+,83 cases,33.3%)and group C(++,31 cases,12.4%).Among the 249 children,the distribution of renal pathological grade was as the following,1 case in gradeⅠ(0.4%),41 cases in gradeⅡa(16.5%),18 cases in gradeⅡb(7.2%),100 cases in gradeⅢa(40.2%),79 cases in gradeⅢb(31.70%),9 cases in gradeⅣ(3.6%)and 1 case in gradeⅤ(0.4%).The degree of C3 deposition was positively correlated with renal pathological grade(r=0.127,P=0.045).In terms of immune indicators,serum complement C3 level was negatively correlated with the degree of C3 deposition in the mesangial region(r=-0.210,P=0.001).The differences in levels of IgA,IgM,C4 and IgG among various groups were not statistically significant(P>0.05).There were significant differences in levels of CD4^(+)/CD8^(+)T and C3 deposition between groups A and B,and also between groups A and C(P<0.05).CD4^(+)/CD8^(+)levels were decreased in most children.There was no significant difference in serum CD3^(+),CD4^(+),CD8^(+)T cell levels among different groups(P>0.05).Based on the above analysis,we conclude that the degree of kidney damage in children with purpuric nephritis is related to the deposition of C3 in the glomerular mesangial region.The stronger the C3 deposition,the heavier the kidney damage,and the lower the

关 键 词：紫癜性肾炎 病理分级 免疫指标 C3沉积 24 h尿总蛋白 

分 类 号：R392.11[医药卫生—免疫学]