| Objectives To explore the immunologic pathogenesis of Henoch-Sch?nlein Purpura (HSP)by analyzing the plasma levels of IL-21, TGF-β1,TNF-αand serum levels of immunoglobulin in children with HSP in acute phase.Material and Methods①53 children with HSP , admitted in the first Affiliated Hospital of Anhui Medical University from 2008 September to 2009 May were enrolled in this study. The diagnosis were established in the light of diagnostic criteria of HSP modified by the European League Against Rheumatism/Paediatric Rheumatology European Society in 2005 .None of patients had other desease and received glucocorticoids and immunosupressants in four weeks before hospitalization. 53 children with HSP were divided into two groups according to clinical manifestation:commom HSP group(30 cases without nephritis), HSPN group( 23 cases with nephritis ). 20 healthy children enrolled in this study as control group.②To collect all children's peripheral blood 4 ml in the morning on an empty stomach. Blood 2ml was set into sample tube containing detate disodium to celect plasma. Blood 2ml was set into commom sample tube to celect serum.All samples were kept as -70℃③The levels of plasma IL-21,IgA1,TGF-β1 and TNF-αwere detected by enzyme-linked immunosorbent assay and serum IgG,IgA,IgM,C3 and C4 were detected with complete—automatic biochemistry analyzer. Serum IgA/C3 ratio was calculated. The statistics analyses were conducted using SPSS 16.0 softwareResults①The levels of plasma IL-21 in children with HSP were significantly lower than those in control group (commom HSP group 148.24±82.10 pg/L,HSPN group 154.24±81.37 pg/L, control group 343.72±302.54 pg/L,F=6.467 p<0.05). The levels of blood IgA ,IgA1,TGF-β1, TNF-αand IgA/C3 ratio in children with HSP were significantly higher than those in control group(In commom HSP group , HSPN group and control group plasma TGF-β1 levels were 5.21±3.09 ng/L,6.95±3.17 ng/L, 2.77±1.72 ng/L, F=9.915 p<0.05;plasma TNF-αlevels were:226.11±119.13 pg/L, 348.99±196.18 pg/L, 127.22±81.23 pg/L,F=11.247 p<0.05;plasma IgA1 levels were: 938.82±362.80 mg/L, 823.02±520.52 mg/L, 404.74±196.34 mg/L, F=12.043 p<0.05;serum IgA levels were: 1.90±0.64 g/L, 2.33±0.71 g/L, 1.29±0.45 g/L,F=13.103 p<0.05;Serum IgA/C3 ratio were 1.52±0.53,2.03±0.73, 1.08±0.29,F=13.825 p<0.05). There were no significantly different between the levels of IgG,IgM,C3and C4 among 3 groups.②The levels of blood TNF-αand IgA/C3 ratio in HSPN group were significantly higher than those in commom HSP group (t=-2.543, t=-2.446,p<0.05). There were no significantly different between the levels of blood IgA ,IgA1,TGF-β1 in commom HSP group with those in HSPN group(p>0.05).③There was significant correlation between the levels of TGF-β1and TNF-αin patients with HSP(r=0.365,p=0.026)and between the levels of IgA and IgA 1(r=0.539,p<0.01). There was no significant correlation between the levels of IgA1 and IL-21 ,TGF-β1(r=-0.247,r=0.116;P >0.05)Conclusions①IL-21, IgA1 ,TGF-β1 and TNF-αmay play a role in the pathogenesisand and pathophysilogic process of HSP in children. The disturburance of cellular immunity and humoral immunity is involved in the pathophysilogic process of HSP..②Plasma TNF-αlevels and serum IgA/C3 ratio in HSPN group were significantly highear than those in commom HSP group .The kidney involvement of HSP may be related with high TNF-αlevels. Serum IgA/C3 ratio may reflect the kidney involvement of HSP . It is still remaining for further investigation whether serum IgA/C3 ratio could be the index in clinical diagnosis,treatment and prognosis...
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