| ObjectiveHenoch-Schonlein Purpura(HSP),also known as Ig A vasculitis,is a common systemicsmall vasculitis,with a high incidence in school-age children,and less incidence in women than in men.According to clinical symptoms,it is divided into simple rash type,abdominal type,joint type,kidney type and mixed type.In recent years,the age of onset of HSP has gradually decreased,and the incidence has gradually increased.The etiology and pathogenesis of HSP are notclear.Multiple factors such as infection,allergic factors,and cellular and humoral immune dysfunction may be involved,but the role of these factors in the pathogenesis of HSP is not clear.T cell immunoglobulin and mucin molecule-3 have been found to have important regulatory effects on T cell immune responses in autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus.There is little research related to HSP,which is also an autoimmune disease.Therefore,this study analyzed the clinical data of 430 children with HSP to determine the risk factors of HSP,and detected the changes of Tim-3 levels in serum of children with HSP to explore the pathogenesis of HSP.MethodsThis study used a retrospective method to select 430 children with allergic purpura admitted to Dalian Children’s Hospital from January 2017 to December 2019,including236 boys and 194 girls,with an average age of 6.98±2.52 years.All met the relevant diagnostic standards in Zhufutang Practical Pediatrics.The included children had previous physical health,no previous history of HSP,no history of glucocorticoids and immunosuppressive agents,no hematological diseases,connective tissue disease,primary glomerular disease,secondary glomerular disease,genetic metabolism History of related diseases and tubular dysfunction.The healthy control group selected 49normal children who attended the child health clinic of our hospital during the same period.The collected organs of 430 children with HSP were different,so we divided them into five groups:101 cases were simple rash group,160 cases were abdominal group,85cases were joint type group,13 cases were kidney type group 71 cases were mixed group.Forty-nine healthy children were the normal control group.The age,sex,allergy history,mycoplasma pneumoniae Ig M antibody,anti-streptococcus O,CD3 level,CD4level,CD8 level,Ig G level,Ig M level,Ig A level,Ig E level,s Tim-3 were compared and analyzed in turn in different groups of patients.Multivariate analysis to calculate independent risk factors for HSP.Data sorting,filtering and statistical analysis with SPSS20.0 software.The measurement data is recorded in the form of.To compare the measurement indexes between the two groups,the independent sample T test was used.The count data was recorded in the form of N(%).The count indexes were compared by the chi-square test.The measurement data of multiple groups were analyzed by one-way ANOVA for overall comparison between the groups,and the differences were statistically significant.The LSD test was used to perform multiple comparisons between groups;Chi-square test was used to compare the inter-group rates(Fisher directly calculated P value with exact probability method if necessary);Step forward:Conditional regression method was used to analyze the statistically significant independent variables in the univariate analysis results by multivariate logistic regression analysis to explore the relevant influencing factors affecting the incidence of purpura.The test level was 0.05,and the difference was statistically significant at P<0.05.Result1.A total of 430 children with first-onset allergic purpura were included in this study.Among them,236 were males(54.88%),196 were females(45.11%),and the male:female ratio was 1.21:1.The mean age of the children was 6.98±2.52 years old.There were more children in the school age group than in other age groups,214,accounting for 49.76%of the total number of children with HSP.The incidence of renal purpura in the adolescent group was higher than that in other age groups.Thec2 test showed that the difference was statistically significant,with a P value of<0.05.Adolescent children were at a high incidence of renal purpura.148 cases occurred for the first time in winter,accounting for 34.42%,and 120 cases occurred for the first time in autumn,accounting for 27.90%,with the highest incidence in winter.2.Taking HSP as the dependent variable,gender,age,history of allergies,presence of positive Mycoplasma pneumoniae Ig M antibodies,anti-streptococcus O above normal,CD3~+levels,CD4~+levels,CD8~+levels,Ig G levels,Ig M levels,Ig A level and Ig E level were independent variables,and multivariate logistic regression analysis was performed.The results showed that streptococcal infection(OR=2.977,P=0.045),Ig A level(OR=3.921,P<0.001),and age(OR=1.616,P<0.001)were independent risk factors for HSP.3.The serum levels of immunoglobulin Ig A(2.20±1.11)and Ig G(11.05±3.45)in children with allergic purpura were higher than those in the normal group(Ig A(1.18±0.57)and Ig G(8.78±1.43).The difference was statistically significant.(P﹤0.01),the content of Ig M(1.29±0.92)in the allergic purpura group was not significantly different from the content of Ig M(1.10±0.36)in the normal control group(P>0.05).Articular Ig G levels(12.11±4.16)were significantly higher than abdominal Ig G levels(10.51±3.08)and mixed Ig G levels(10.85±3.13),with significant differences and statistical significance(P<0.05).4.The serum level of s Tim-3(105.67±24.75)in the children with HSP group was lowerthan that in the normal control group(135.96±23.22),and there was a significant difference(P<0.05).Conclusion1.Autumn and winter are the seasons of high incidence of HSP,school-age children are the age of high incidence of HSP,and puberty is the age of high incidence of renal purpura;2.Age,Ig A level and anti-streptoxin O level were positively correlated with the occurrence of HSP.In older age groups,increased Ig A and anti-streptococcin O were independent risk factors for HSP.3.Children with HSP have abnormal humoral immune function in the acute phase,which is manifested by increased levels of immunoglobulin Ig A and Ig G,and the level of Ig G in joint allergic purpura is more significant.4.The serum Tim-3 level in children with HSP is significantly reduced,suggesting that Tim-3 may be involved in HSP cell immune disorders,which is one of the important pathogenesis of HSP... |
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