辅助性和调节性T淋巴细胞亚群与过敏性紫癜患儿疾病严重程度的关系  

Association of helper and regulatory T lymphocyte subsets with disease severity in children with Henoch-Schonlein purpura

作　　者：张丽丽[1] 林慧晶 吴明赴[1] 季正华[2] 李晓忠[2] ZHANG Lili;LIN Huijing;WU Mingfu;JI Zhenghua;LI Xiaozhong(Affiliated Hospital of Yangzhou University,Jiangsu Yangzhou 225000,China;Children's Hospital of Soochow University,Jiangsu Suzhou 215003,China)

机构地区：[1]扬州大学附属医院,江苏扬州225000 [2]苏州大学附属儿童医院,江苏苏州215003

出　　处：《中国妇幼健康研究》2023年第8期47-55,共9页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨辅助性(Th)(CD3^(+)CD4^(+))和调节性(Treg)(CD4^(+)CD25^(+))T淋巴细胞亚群与过敏性紫癜(HSP)患儿疾病严重程度的关系。方法 选择2018年1月至2021年1月苏州大学附属儿童医院收治的HSP患儿(150例)为研究对象,根据HSP症状积分将其分为轻度组(<33分,50例)、中度组(33~67分,56例)、重度组(>67分,44例);另选择同期于门诊进行体检的健康儿童(150例)为对照组。对比分析各组儿童的一般资料、临床症状及实验室指标。通过曲线拟合及阈值效应分析CD3^(+)CD4^(+)和CD4^(+)CD25^(+)与HSP症状积分的关系。通过LASSO模型和多因素Logistic回归分析探讨HSP患儿病情加重的影响因素,建立反向传播(BP)神经网络模型,并对模型进行评价。结果 轻度组、中度组、重度组患儿皮肤紫癜持续时间>28d的比例比较差异有统计学意义(χ^(2)=6.340,P<0.05)。轻度组、中度组、重度组、对照组儿童的白细胞计数(WBC)、C-反应蛋白(CRP)、D-二聚体(D-D)、免疫球蛋白A(IgA)、CD3^(+)CD4^(+)、CD4^(+)CD25^(+)、白细胞介素-21(IL-21)、转化生长因子β1(TGF-β1)及肿瘤坏死因子α(TNF-α)水平比较差异均有统计学意义(F值分别为6.559、9.707、29.202、12.719、7.671、5.290、10.226、19.119、13.329,P<0.05),随着HSP病情加重,WBC、CRP、D-D、IgA、TGF-β1及TNF-α水平均有所升高,而CD3^(+)CD4^(+)、CD4^(+)CD25^(+)及IL-21水平均有所降低。随着HSP患儿病情的进展,CD3^(+)CD4^(+)和CD4^(+)CD25^(+)的水平均有所下降,当CD3^(+)CD4^(+)<37.3%时,随着CD3^(+)CD4^(+)水平升高,HSP症状积分呈下降趋势(OR=0.962,95%CI:0.947~0.977,P<0.001);当CD4^(+)CD25^(+)<10.2%时,随着CD4^(+)CD25^(+)水平升高,HSP症状积分呈下降趋势(OR=0.976,95%CI:0.953~0.998,P<0.001)。多因素Logistic回归分析显示,CRP>12.4mg/L(OR=5.017,95%CI:4.609~5.811)、D-D>3.4mg/L(OR=4.391,95%CI:4.051~5.132)、IgA>2.3g/L(OR=3.148,95%CI:2.742~3.524)、TGF-β1≥6.5pg/mL(OR=4.137,95%CI:3.372~4.512)及TNF-α≥14.5pgObjective To explore the relationship between helper(Th)(CD3^(+)CD4^(+)) and regulatory(Treg)(CD4^(+)CD25^(+)) T lymphocyte subsets and disease severity in children with henoch-schonlein purpura(HSP).Methods A total of 150 children with HSP who admitted to Children's Hospital of Soochow University from January 2018 to January 2021 were selected as the research subjects,and according to the HSP symptom score,they were divided into mild group(33 points,50 cases),moderate group(33-67 points,56 cases,),and severe group(67 points,44 cases).Healthy children(150 cases) who underwent physical examination in the outpatient department of the hospital during the same period were selected as the control group.The general data,clinical symptoms and laboratory indexes of children in each groups were compared and analyzed.The relationship between CD3^(+)CD4^(+) and CD4^(+)CD25^(+) and HSP symptom score was analyzed by curve fitting and threshold effect analysis.LASSO model and multivariate Logistic regression analysis was used to explore the factors affecting the exacerbation of HSP children,and back propagation(BP) neural network model was established,and the model was evaluated.Results There was significant difference between the mild group,the moderate group and the severe group in the duration of purpura28 days(χ^(2)=6.340,P<0.05).The levels of white blood cell(WBC),C-reactive protein(CRP),D-dimer(D-D),immunoglobulin A(IGA),CD3^(+)CD4^(+),CD4^(+)CD25^(+),interleukin-21(IL-21),transforming growth factor β1(TGF-β1) and tumor necrosis factor α(TNF-α) were significantly different in children in mild group,moderate group,severe group and control group(F=6.559,9.707,29.202,12.719,7.671,5.290,10.226,19.119 and 13.329,respectively,P<0.05).With the exacerbations of HSP,the levels of WBC,CRP,D-D,IGA,TGF-β1 and TNF-α were increased,while the levels of CD3^(+)CD4^(+),CD4^(+)CD25~(+ )and IL-21 were decreased.With the progression of HSP,the levels of CD3^(+)CD4^(+) and CD4^(+)CD25^(+) decreased,when CD3^(+)CD4^(+)37.3%,with the in

关 键 词：过敏性紫癜 辅助性T淋巴细胞 调节性T淋巴细胞 疾病严重程度 相关性 

分 类 号：R179[医药卫生—妇幼卫生保健]