Changes Of Peripheral Blood Lymphocyte Subsets And Immune Function In Children With Henoch-Schonlein Purpura Nephritis

Objective:Henoch-Schonlein Purpura,also known as IgA vasculitis,is a leukocytoclastic type of vasculitis,which is caused by the deposition of immune IgA complexes in small blood vessels throughout the body.Its clinical features are non-thrombocytopenic palpable skin purpura,arthralgia(or arthritis),gastrointestinal and renal involvement.In recent years,its incidence in children is increasing year by year.Henoch-Schonlein purpura nephritis is a serious complication of Henoch-Schonlein purpura and the most common secondary glomerular disease in childhood.However,its pathogenesis is still unclear.At present,it is believed that the pathogenesis may be various infections,which act on individuals with different genetic backgrounds,result in immune system dysfunction,and lead to the occurrence of diseases.In this study,we detected the changes of serum IgA,IgM,IgG,C3,C4,CD3+,CD4+,CD8+,CD4+/CD8+,CD19+ and NK cells in children with Henoch-Schonlein purpura to understand the characteristics of humoral and cellular immunity and the relationship between them and Henoch-Schonlein purpura nephritis,in order to further understand its pathogenesis and provide new ideas for further treatment and prognosis.Methods:The subjects were 104 children with Henoch-Schonlein purpura who were hospitalized in the Department of Kidney Immunology and Rheumatism,The Second Hospital of Hebei Medical University from April 2017 to November 2018.They were divided into two groups:nephritis(HSPN)group and non-nephritis(HSPN)group according to clinical renal damage.Among them,68 cases were NHSPN and 36 cases were HSPN.At the same time,15 normal children were selected as the control group.Immunoglobulin IgA,IgG,IgM,C3 and C4 were measured by Immune transmission turbidimetry.The levels of CD3+,CD4+,CD8+,CD4+/CD8+,CD19+,NK lymphocyte subsets in peripheral blood mononuclear cells were measured by flow cytometry.Then SPSS 21.0 software was used to describe and analyze the statistics.The normal distribution was expressed by mean and standard deviation,and the non-normal distribution was expressed by median and quartile.All the original data were tested by normal distribution test.The differences of IgA,IgG,IgM,C3,C4,CD3+,CD4+,CD8+,CD4+/CD8+,CD19+,NK,age and other indicators among the three groups were compared by single factor analysis of variance.If the difference between the two groups was consistent with the homogeneity test of variance,LSD test was used to compare the difference between the two groups.If the difference was not consistent with the homogeneity test of variance,then SNK test was used.Chi-square test was used to compare the counting data between groups.P < 0.05 means the difference has statistical significance.Results:1.Among 104 children,56 were male and 48 were female,aged between 3 and 14 years,with an average age of(8.5 ± 2.5)years.There was no significant difference in age and sex among the three groups(P > 0.05).2.The levels of CD3+,CD4+,CD8+ and NK cells in peripheral blood mononuclear cells in HSPN group and NHSPN group decreased significantly,and the difference between the two groups and the normal control group was statistically significant(P < 0.05);the level of CD19+ increased significantly,and the difference between the two groups and the normal control group was statistically significant(P < 0.05);the levels of CD3+,CD4+,CD8+,CD19+ in HSPN group were higher than those in NHSPN group,and the difference was statistically significant(P < 0.05).The level of NK cells decreased with statistical significance(P < 0.05).There was no statistical difference in the level of CD4+ / CD8+ among the three groups(P > 0.05).3.The serum IgA and IgG of HSPN group and NHSPN group increased significantly,while IgM,C3 and C4 decreased significantly,with significant difference between the two groups and the control group(P < 0.05);there was no significant difference in IgA and IgM between HSPN group and NHSPN group(P > 0.05);IgG,C3 and C4 of HSPN group decreased significantly compared with NHSPN group(P < 0.05).Conclusions:The chilgren with HSPN has the disorder of cellular and humoral immune function,which is manifested by low cellular immune function,resulting in increased secretion of inflammatory mediators,activation of B cells and increased secretion of immunoglobulin,leading to the occurrence of small vessel vasculitis;in which the level of IgM decreases,considering the existence of immunodeficiency of IgM.The levels of C3 and C4 are significantly reduced,and the function of complement system is low.