过敏性紫癜及紫癜性肾炎患儿外周血B淋巴细胞的特征  

Characteristics of peripheral blood B lymphocytes in children with Henoch-Schönlein purpura and Henoch-Schönlein purpura nephritis

作　　者：周楠[1,2,3] 刘曼 宋浩斌 赵青 常梦林 王明华 陈超 ZHOU Nan;LIU Man;SONG Haobin;ZHAO Qing;CHANG Menglin;WANG Minghua;CHEN Chao(Department of Nephrology,Baoding Hospital,Beijing Children’s Hospital,Capital Medical University,Baoding Hebei 071001;Department of Nephrology,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045;Basic and Clinical Laboratory of Pediatric Nephrology,Baoding Hospital,Beijing Children’s Hospital,Capital Medical University,Baoding Hebei 071001;Department of Clinical Laboratory,Baoding Hospital,Beijing Children’s Hospital,Capital Medical University,Baoding Hebei 071001,China)

机构地区：[1]首都医科大学附属北京儿童医院保定医院肾内科,河北保定071001 [2]国家儿童医学中心,首都医科大学附属北京儿童医院肾内科,北京100045 [3]首都医科大学附属北京儿童医院保定医院儿童肾脏基础与临床重点实验室,河北保定071001 [4]首都医科大学附属北京儿童医院保定医院检验科,河北保定071001

出　　处：《临床与病理杂志》2023年第12期2099-2105,共7页Journal of Clinical and Pathological Research

基　　金：保定市科技计划项目(2141ZF280,2241ZF077);河北省卫生健康委员会医学科学研究课题(20230255)。

摘　　要：目的:通过分析过敏性紫癜(Henoch-Schönlein purpura,HSP)及紫癜性肾炎(Henoch-Schönlein purpura nephritis,HSPN)患儿外周血B细胞及免疫球蛋白A^(+)(immunoglobulin A^(+),IgA^(+))B细胞水平,初步探讨B细胞在HSP及HSPN中的变化趋势及特征。方法:回顾性分析2018年5月至2022年2月确诊的HSP患儿163例,分为HSP不伴肾炎组(HSP-wN组,130例)及HSPN组(33例),分析外周血B细胞水平。纳入2022年12月至2023年5月的18例HSP患儿(FC-HSP组),其中含HSPN的患儿8例(FC-HSPN组),同时纳入体检正常的23例儿童为正常对照组(NC组),再进一步采用流式细胞仪检测。检测B细胞、IgA^(+)B细胞及肠源性IgA^(+)B细胞水平,分析FC-HSP组与FC-HSPN组患儿各细胞水平的特征差异。结果:HSPN组B细胞水平低于HSP-wN组,2组间比较差异有统计学意义(P<0.05)。HSPN组中有消化道症状者B细胞比例显著高于无消化道症状者(P<0.05)。流式细胞仪检测显示:与NC组相比,FC-HSP组患儿外周血B淋巴细胞比例显著降低(P<0.05);2组间外周血浆细胞差异无统计学意义(P=0.45);与NC组相比,HSPN组的IgA^(+)B细胞显著升高(P<0.05);FC-HSP组和FC-HSPN组肠源性IgA^(+)整合素β7^(+)(IgA^(+)Integrinβ7^(+))B细胞均显著升高(分别P<0.05,P<0.01);IgA^(+)趋化因子受体9^(+)(IgA^(+)chemokine receptor 9^(+),IgA^(+)CCR9^(+))B细胞差异无统计学意义(P>0.05)。单纯表达肠源性标志物的B细胞(包括CCR9^(+)B细胞、integrinβ7^(+)B细胞、CCR9^(+)integrinβ7^(+)B细胞)比较差异均无统计学意义(均P>0.05)。结论:HSPN患儿外周血B细胞水平下降,但IgA^(+)B细胞水平升高,尤其是肠源性IgA^(+)integrinβ7^(+)B细胞升高,提示肠道黏膜免疫异常导致肠源性IgA^(+)B细胞活化可能参与疾病的致病机制。Objective:To explore the characteristics of peripheral blood B cells and immunoglobulin A^(+)(IgA^(+))B cells in children with Henoch-Schönlein purpura(HSP)and Henoch-Schönlein purpura nephritis(HSPN).Methods:A retrospective analysis was conducted on 163 children diagnosed with HSP from May 2018 to February 2022,divided into 2 groups:130 cases without nephritis(HSPwN group)and 33 cases with HSPN(HSPN group).Peripheral blood B cell levels were detected.Flow cytometry was further used to detect B cells and IgA^(+)B cells in 18 HSP children(FC-HSP group)from December 2022 to May 2023,including 8 cases with HSPN(FC-HSPN group),and a normal control group(NC group,n=23)was set up.The levels of B cells,IgA^(+)B cells,and intestinal-derived IgA^(+)B cells were measured,and the differences in cell levels between the FC-HSP group and the FC-HSPN group were analyzed.Results:The level of B cells in the HSPN group was significantly lower than that in the HSP-wN group(P<0.05).In the HSPN group,children with gastrointestinal symptoms had a significantly higher proportion of B cells than those without gastrointestinal symptoms(P<0.05).Flow cytometry analysis showed that compared with the NC group,the proportion of peripheral blood B cells in children in the FC-HSP group was significantly decreased(P<0.05),there was no statistically significant difference in peripheral plasma cells between the 2 groups(P=0.45).Compared with the NC group,the IgA^(+)B cells in the HSPN group were significantly increased(P<0.05),the levels of intestinal-derived cells IgA^(+)integrinβ7^(+)B cells were significantly increased in the FC-HSP group and the FCHSPN group(both P<0.05 and P<0.01,respectively).There was no statistically significant difference in the IgA^(+)chemokine receptor 9^(+)(CCR9^(+))B cells among the 3 groups(all P>0.05).There was no statistically significant difference in B cells expressing enterogenic markers alone(including CCR9^(+)B cells,integrinβ7^(+)B cells,CCR9^(+)integrinβ7^(+)B cells)among the 3 groups(all P>0.05).Conclu

关 键 词：过敏性紫癜 紫癜性肾炎 B淋巴细胞 

分 类 号：R725.5[医药卫生—儿科] R726.9[医药卫生—临床医学]