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

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1、紫藏性肾炎患J1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Th17和调节性T细胞平衡的关系。方法：将医院从2017年1月2023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，Th17和调节性T细胞比例以及Th17细胞

2、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Th17和调节性T细胞平衡的相关性。结果：研究组血清BAFF水平为(0.650.20)g1,低于HSP组的(1.270.44)HgZ1及对照组的(1.280.45)g1,而血清MK水平为(314.2280.14)pgm1,高于HSP组的(176.1248.91)pg/m1及对照组的(1013240.36)pg/m1,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(17373.25)mg/

3、dk(1.270.34)mg/dk(0.450.08)mg1,均高于HSP组的(0.780.21)mg/dk(0.180.05)mg/dk(O.22O.O3)mg1,以及对照组的(0.720.25)mg/dk(0.17K).02)mg/dk(0.21().04)mg/1(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P0.05)三组间尿素城及肌醉水平相比，差异无统计学意义(P0.05)研究组Th17细胞比例以及血清I1-6、I1-I7水平分别为(1.56+0.35)%、(21.455.11)pg/m1、(91.56+20.15)ng1,明显高于

4、HSP组的(0.6810.14)%、(I4.723.10)pg/m1、(45.IO14.56)ng1,而调节性T细胞比例为(2.510.52)%,明显低于HSP组的(6.311.37)%,且HSP组ThI7细胞比例以及血清I1-6sI1-17水平明显高于对照组的(0,520.11)%、(I0.442.()9)pg/m1、(20.623.92)ng1,而调节性T细胞比例明显低于对照组的(7.911.44)%(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I16、I1I7均呈负相关，与调节性T细胞比例呈正相关；血清MK

5、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I1-6、I1/7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Th17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：Th17细胞；调节性T细胞There1ationshipbetweenserumBAFFandMK1eve1sandkidneyinjuryandTh17andregu1atoryTce11ba1anceinchi1drenwithPurpuranephr

6、itisXieYu-fei,MaCai-xia,Yang1i-pingDepartmentofPediatrics.QingpuBranchofZhongshanHospita1Affi1iatedtoFudanUniversity,Shanghai,201700AbstractObjective:Tostudythere1ationshipbetweenserumB1ymphocyteactivatingfactor(BAFF)andintermediatefactor(MK)1eve1sandrena1injuryandTh17andregu1atoryTce11ba1anceinchi1

7、drenwithPurpuranephritis(HSPN).Methods:Atota1of71chi1drenwithHSPNadmittedtoourhospita1fromJanuary2017toJanUary2023wereinc1udedinthestudyandrecordedasthestudygroup.Another70chi1drenwithHenoch-Schon1einpurpura(HSP)admittedtohospita1duringthesameperiodwerese1ectedasHSPgroup.70hea1thychi1drenwhoundenven

8、tphysica1examinationinhospita1duringthesameperiodwerese1ectedasthecontro1group.T1iedifferencesinserumBAFFandMK1eve1s,rena1injury-re1atedindexes1eve1s.Th17andregu1atoryTce11sproportionandTh17ce11-re1atedfactorsamongthethreegroupsweredetectedandcompared.Preasoncorre1ationwasusedtoana1yzethecorre1ation

9、betweenserumBAFFandMK1eve1sandrena1injuryandba1anceofTh17andregu1atorTce11s.Resu1ts:TheserumMK1eve1ofHSPgroupwas(0.650.20)g1,1owerthanthatofHSPgroup(1.27().44)g1andcontro1group(1.280.45)g1,whi1etheserumMK1eve1ofHSPgroupwas(314.2280.14)pgm1,higherthanthatofHSPgroup(I76.1248.91)pg/m1andcontro1group(IO

10、I.324O.36)pg/m1.TheserumMK1eve1ofHSPgroupwashigherthanthatofcontro1group(bothP0.05).The1eve1sofurinarymicrog1obu1in,urinarj,transferrinandurinary-microg1obu1ininthestudyg)upwere(I7.373.25)mgd1,(1.27O.34)mg/d1and(0.450.08)mg/1respective1y,whichwerehigherthanthoseintheHSPgroup(0.780.21)mg/d1,(0.180.05

11、)mg/d1,(0.22().()3)mg1,andhigherthanthoseinthecontro1group().72O.25)mg/d1,(0.170.02)mg/d1,(0.210.04)mg/1(a11P0.05).Therewasnosignificantdifferenceinureanitrogenandcreatinine1eve1samongthethreegroups(P0.05).TheproportionofTh17ce11s,serumI1-6andI1-17inthestudygroupwere(1.560.35)%,(21.455.11)pg/m1and(9

12、1.5620.15)ng1,respective1y,whichweresignificant1yhigherthanthatoftheHSPgroup(O.68O.I4)%,(14.723.IO)pg/m1and(45.1(14.56)ng1,whi1etheproportionofregu1atoryTce11swas(2.510.52)%,whichwasSignifiCant1y1owerthanthatoftheHSPgroup(6.311.37)%.TheproportionofTh17ce11sandscrumI1-6andI1-171eve1sinHSPgroupweresig

13、nificant1yhigherthanthoseincontro1group(O.52O.11)%,(10.442.09)pg/m1and(20.623.92)ng1,whi1etheproportionofregu1atoryTce11swassignificant1y1owerthanthatincontro1gn)up(7.911.44)%(a11P0.05).Preasoncorre1ationana1ysisshowedthatserumBAFFwasnegative1ycorre1atedwiththeproportionofTh17ce11s,urinarymicroa1bum

14、in,urinarytransferrin,urinary-microg1obu1in,serumI1-6andI1-17,andpositive1ycoe1atedwiththeproportionofregu1atoryTce11s.SerumMKwaspositive1ycorre1atedwiththeproportionofTh17ce11s,urinarymicroa1bumin,urinarytransferrin,urinary-microg1obu1in,serumI1-6andI1-17.andnegative1ycorre1atedwiththeproportionofr

15、egu1atoryTce11s(a11P0.05).Conc1usion:Thereareabnona11y1owexpressionofserumBAFF.andabnorma11yhighexpressionofMKinchi1drenwithHSPN,bothofwhicharec1ose1yre1atedtokidneyinjuryandTh!7andregu1atoryTce11ba1anceinchi1dren,whicharedeservedc1inica1attention.KeywordsPurpuranephritis;B1ymphocyteactivatingfactor;Intennediatefactor;Kidneyinjury;Th17ce11s;Regu1atoryTce11s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I1若不及时给予治疗，则可能导