The Study Of The Pathogenesis Of IgA Nephropathy Mucosal Immunity And The Effect Of Tripterygium Wilfordii Polyglycoside Tablets On IgA Nephropathy Mucosal Immunity

Background and purposeIgA Nephropathy(IgAN)is the most common primary glomerular disease in the world.Its clinical and pathological manifestations are diverse.About 30%-40%of patients progress to the end-stage renal disease within 20 years.The diagnosis of IgAN mainly relies on the immunopathology of renal biopsy,which is a pathological concept.At present,the pathogenesis of IgAN is not completely clear.IgAl molecules with abnormal 0glycosylation are considered by many scholars in the academic field to play a key role in the pathogenesis of IgAN.The current results show that budesonide,a targeted released formula-TRF targeted at Peyer’s patches(PP)in the terminal ileum,can significantly reduce proteinuria levels in patients with IgAN and reduce the risk of progression to end-stage renal disease.It is suggested that upstream intestinal mucosal immunity plays a very important role in the pathogenesis of IgAN.Therefore,exploring the pathogenic mechanism of upstream intestinal mucosal immunity in IgAN is an emerging research focus in the field of IgAN.Previous studies have reported abnormal changes in B lymphocyte subsets in IgAN patients compared with healthy controls,and are associated with elevated urine protein levels.However,the changes and roles of intestinal mucosa-derived B cell subsets in IgAN have not yet been clarified.In our study,we designed to compare the differences between B cell subsets from intestinal mucosa in IgAN patients with healthy controls.And we aim at finding the correlations between B lymphocyte subsets with IgA and IgA1 levels.And we also find the differences in cytokines between IgAN and healthy controls.In addition,we aim to look for the correlations between the common tongue image information with clinical indicators of IgAN patients,and to observe the changes of T and B cell subsets in IgAN patients after taking the tripterygium glycosides.Methods:1.The study included 52 IgAN patients and 48 healthy controls.Freshly drawn peripheral blood was collected from the patients,and peripheral blood mononuclear cells(PBMC)were extracted for flow cytometry to detect B lymphocytes.Cells were subjected to subpopulation analysis.2.ELISA method was used to detect the level of IgAl molecules in plasma,and to analyze the correlation between IgAl molecules and B lymphocyte subsets.3.The cytokine levels of IgAN patients and healthy controls were measured by CBA and Luminex.4.Sixty-five IgAN patients were included in the study.The tongue information of the patients was collected and analyzed with clinical indicators.5.34 patients with IgAN were included in the study and freshly drawn peripheral blood was collected.PBMCs were extracted for flow cytometry,and T and B lymphocytes were analyzed for subpopulations.Results:1.In this study,we found that the proportion of CD3-CD19+CD20-CD27+PB cells,Integrin β7+PB cells,IgA+PB cells that secrete IgA molecules was significantly higher than that of healthy controls.The interleukin(IL)6 level in plasma in IgAN patients was significantly higher than that in healthy controls,and the vascular endothelial growth factor(VEGF)level was significantly lower than that in healthy controls.2.The levels of IgA,IgAl,and IgM in plasma of IgAN patients were significantly higher than those in healthy controls,while the level of IgG significantly lower than it in healthy controls.There was no correlation between PB cells subsets and the level of IgA from plasma.3.The common tongue image of IgAN patients in this study is pale,red tongue coated with yellow thick moss.However,no statistical significance was found in the relationship between the tongue image and clinical indicators in IgAN patients in this study.4.The urinary albumin/creatinine ratio of IgAN patients after 6 weeks’treatment of tripterygium wilfordii polyglycoside was significantly lower than before.There were no significant changes in T and B cells subsets in IgAN patients before and after the use of tripterygium glycosides.Conclusion:This study found abnormal B cells subsets in peripheral blood of patients with IgA nephropathy and provided laboratory basis and theoretical clues for the research and clinical diagnosis and treatment of IgA nephropathy.