紫癜性肾炎患儿血清BAFF、MK水平与肾损伤及Th17和调节性T细胞平衡的关系研究.docx

紫藏性肾炎患JL±清BAFF.MK水平与肾损伤及Thl7和调节性T细胞平衡的关系研究谢宇飞，马彩霞，杨丽萍复旦大学附属中山医院青浦分院儿科上海201700【摘要】目的：研究紫瘢性肾炎(HSPN)患儿血清B淋巴细胞活化因子(BAFF)、中期因子(MK)水平与肾损伤及Thl7和调节性T细胞平衡的关系。方法：将医院从2017年1月2020年1月收治的71例HSPN患儿纳入研究，记作研究组。另取同期医院收治的过敏性紫瘢(HSP)患儿70例作为HSP组。另取同期于医院体检的健康志愿儿童70例作为对照组。检测并比较三组患儿血清BAFF、MK水平，皆损伤相关指标水平，Thl7和调节性T细胞比例以及Thl7细胞相关因子水平等方面的差异，来用Preason相关性分析血清BAFF.MK水平与肾损伤及Thl7和调节性T细胞平衡的相关性。结果：研究组血清BAFF水平为(0.65±0.20)gL,低于HSP组的(1.27±0.44)HgZL及对照组的(1.28±0.45)gL,而血清MK水平为(314.22±80.14)pgml,高于HSP组的(176.12±48.91)pg/ml及对照组的(10132±40.36)pg/ml,其中HSP组血清MK水平高于对照组(均PVO.05),HSP组血消BAFF水平与对照组比较无明显差异(尸>0.051.研究组尿微量白蛋白、尿转铁蛋白以及尿微球蛋白水平分别为(1737±3.25)mg/dk(1.27±0.34)mg/dk(0.45±0.08)mgL,均高于HSP组的(0.78±0.2l)mg/dk(0.l8±0.05)mg/dk(O.22±O.O3)mgL,以及对照组的(0.72±0.25)mg/dk(0.l7K).02)mg/dk(0.2l±().04)mg/L(均TVo.05),而HSP组尿微量门蛋白、尿转铁蛋白以及尿微球蛋白水平与对照组比较无明显差异(均P>0.05)°三组间尿素城及肌醉水平相比，差异无统计学意义(P>0.05)»研究组Thl7细胞比例以及血清IL-6、IL-I7水平分别为(1.56+0.35)%、(21.45±5.11)pg/ml、(91.56+20.15)ngL,明显高于HSP组的(0.6810.14)%、(I4.72±3.10)pg/ml、(45.IO±14.56)ngL,而调节性T细胞比例为(2.51±0.52)%,明显低于HSP组的(6.31±1.37)%,且HSP组ThI7细胞比例以及血清IL-6sIL-17水平明显高于对照组的(0,52±0.ll)%、(I0.44±2.()9)pg/ml、(20.62±3.92)ngL,而调节性T细胞比例明显低于对照组的(7.9田.44)%(均PVo.05)。经PrCaSOn相关性分析可得：血清BAFF与ThI7细胞比例、尿微量白蛋白、尿转铁蛋白、尿微球蛋白以及血清IL6、ILI7均呈负相关，与调节性T细胞比例呈正相关；血清MK与ThI7细胞比例、尿微量白蛋白、尿转铁蛋白、尿。微球蛋白以及血清IL-6、IL/7均呈正相关，与调节性T细胞比例呈负相关(均PV0.05)°结论，HSPN患儿血清BAFF存在异常低表达，而MK存在异常高表达，两者均和患儿肾损伤以及Thl7和调节性T细胞平衡密切相关，值得临床重点关注。【关键词】紫搬性肾炎；B淋巴细胞活化因子；中期因子；肾损伤：Thl7细胞；调节性T细胞TherelationshipbetweenserumBAFFandMKlevelsandkidneyinjuryandTh17andregulatoryTcellbalanceinchildrenwithPurpuranephritisXieYu-fei,MaCai-xia,YangLi-pingDepartmentofPediatrics.QingpuBranchofZhongshanHospitalAffiliatedtoFudanUniversity,Shanghai,201700AbstractObjective:TostudytherelationshipbetweenserumBlymphocyteactivatingfactor(BAFF)andintermediatefactor(MK)levelsandrenalinjuryandTh17andregulatoryTcellbalanceinchildrenwithPurpuranephritis(HSPN).Methods:Atotalof71childrenwithHSPNadmittedtoourhospitalfromJanuary2017toJanUary2020wereincludedinthestudyandrecordedasthestudygroup.Another70childrenwithHenoch-Schonleinpurpura(HSP)admittedtohospitalduringthesameperiodwereselectedasHSPgroup.70healthychildrenwhoundenventphysicalexaminationinhospitalduringthesameperiodwereselectedasthecontrolgroup.TliedifferencesinserumBAFFandMKlevels,renalinjury-relatedindexeslevels.Th17andregulatoryTcellsproportionandTh17cell-relatedfactorsamongthethreegroupsweredetectedandcompared.PreasoncorrelationwasusedtoanalyzethecorrelationbetweenserumBAFFandMKlevelsandrenalinjuryandbalanceofTh17andregulator'Tcells.Results:TheserumMKlevelofHSPgroupwas(0.65÷0.20)gL,lowerthanthatofHSPgroup(1.27±().44)gLandcontrolgroup(l.28±0.45)gL,whiletheserumMKlevelofHSPgroupwas(314.22±80.14)pgml,higherthanthatofHSPgroup(I76.12±48.9l)pg/mlandcontrolgroup(IOI.32±4O.36)pg/ml.TheserumMKlevelofHSPgroupwashigherthanthatofcontrolgroup(bothP<0.05),andthescrumBAFFlevelofHSPgroupwasnotSigniHcantlydiflercntfromthatofcontrolgroup(P>0.05).Thelevelsofurinarymicroglobulin,urinarj,transferrinandurinary-microglobulininthestudyg)upwere(I7.37±3.25)mgdl,(1.27±O.34)mg/dland(0.45±0.08)mg/Lrespectively,whichwerehigherthanthoseintheHSPgroup(0.78±0.21)mg/dl,(0.18±0.05)mg/dl,(0.22±().()3)mgL,andhigherthanthoseinthecontrolgroup().72±O.25)mg/dl,(0.17±0.02)mg/dl,(0.21±0.04)mg/L(allP<0.05),butthelevelsofurinarymicroalbumin.urinarytransierrinandurinarymicroglobulininHSPgroupwerenotsignicantlydiIIcrentfromthoseinthecontrolgroup(allP>0.05).Therewasnosignificantdifferenceinureanitrogenandcreatininelevelsamongthethreegroups(P>0.05).TheproportionofTh17cells,serumIL-6andIL-17inthestudygroupwere(1.56±0.35)%,(2l.45±5.11)pg/mland(9l.56±20.15)ngL,respectively,whichweresignificantlyhigherthanthatoftheHSPgroup(O.68±O.I4)%,(14.72±3.IO)pg/mland(45.1(>±14.56)ngL,whiletheproportionofregulatoryTcellswas(2.51±0.52)%,whichwasSignifiCantlylowerthanthatoftheHSPgroup(6.31±1.37)%.TheproportionofTh17cellsandscrumIL-6andIL-17levelsinHSPgroupweresignificantlyhigherthanthoseincontrolgroup(O.52±O.l1)%,(10.44±2.09)pg/mland(20.62±3.92)ngL,whiletheproportionofregulatoryTcellswassignificantlylowerthanthatincontrolgn)up(7.91±1.44)%(allP<0.05).PreasoncorrelationanalysisshowedthatserumBAFFwasnegativelycorrelatedwiththeproportionofThl7cells,urinarymicroalbumin,urinarytransferrin,urinary-microglobulin,serumIL-6andIL-17,andpositivelycoelatedwiththeproportionofregulatoryTcells.SerumMKwaspositivelycorrelatedwiththeproportionofTh17cells,urinarymicroalbumin,urinarytransferrin,urinary-microglobulin,serumIL-6andIL-17.andnegativelycorrelatedwiththeproportionofregulatoryTcells(allP<0.05).Conclusion:ThereareabnonallylowexpressionofserumBAFF.andabnormallyhighexpressionofMKinchildrenwithHSPN,bothofwhicharecloselyrelatedtokidneyinjuryandTh!7andregulatoryTcellbalanceinchildren,whicharedeservedclinicalattention.KeywordsPurpuranephritis;Blymphocyteactivatingfactor;Intennediatefactor;Kidneyinjury;Th17cells;RegulatoryTcells紫瘢性肾炎(HSPN)属于过敏性紫蝴(HSP)患者较为严重的种并发症，亦是临床发病率较高的一种维发性肾脏疾病IL若不及时给予治疗，则可能导致患