The Changes And Significance Of Intestinal Flora In Children With Henoch-Schonlein Purpura

ObjectiveTo study changes in the intestinal flora of children with Henoch-Schonlein purpura,and the correlation between intestinal flora and fecal calprotectin and lymphocyte subsets was analyzed,to investigate the changes of intestinal flora of Henoch-Schonlein purpura and its role in the occurrence and development of disease.Methods37 cases of newly diagnosed Henoch-Schonlein purpura treated in the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University from July 2019 to September 2019 were selected as the study group(group A),another 12 healthy children were selected as the control group(group B);follow-up for children with Henoch-Schonlein purpura for 6 months,grouping based on the presence or absence of kidney injury,children without kidney injury were group Al,and children with kidney injury were group A2,that was Henoch-Schonlein purpura nephritis group.General information on children with Henoch-Schonlein purpura and children in healthy controls were collected,including indicators such as age,gender,height,weight;and data of lymphocyte subsets,immunoglobulin and complement assay,blood routine and CRP were collected in children with Henoch-Schonlein purpura.The fecal calprotectin levels of all subjects were detected by ELISA.In addition,high-throughput sequencing technology was used to sequence and analyze the intestinal flora of all subjects.LEfSe analysis to find species with significant differences between groups,and spearman correlation analysis was used to find the genus that had correlations with fecal calprotectin and lymphocyte subsets.Results1.37 cases in group A and 12 cases in group B,all Han,there were no significant differences in gender,age,and BMI between the two groups(P>0.05).13 cases in group A1 and 24 cases in group A2,there were no significant differences in gender,age,and BMI between each of the group A1,group A2 and group B(P>0.05).2.The absolute counts of total lymphocytes,the absolute count of T lymphocytes and the absolute count of helper T lymphocytes in group A2 were higher than those in group Al,the differences were statistically significant(P<0.05);there was no statistically significant difference in the absolute count of suppressor T lymphocytes,the absolute count of B lymphocyte,WBC,Neut#,Lymph#,Mono#,CRP,IgG,IgA,IgM,IgE,C3 and C4 between the two groups(P>0.05).3.There was no significant difference in fecal calprotectin between group A and group B(P>0.05);comparison of fecal calprotectin between group A1,group A2 and group B,the difference was statistically significant(P<0.05),further line-by-line comparison results showed that the fecal calprotectin level in group A2 was higher than that in group A1 and group B,and the differences were statistically significant(P<0.05).4.There was no significant difference in Shannon index,Chao1 index,and ACE index between group A and group B(P>0.05),there were no significant difference in Shannon index,Chaol index,and ACE index between each of the group A1,group A2 and group B(P>0.05);it was suggested that there was no significant difference in the abundance and diversity of intestinal flora between the groups.5.PCoA analysis showed that the intestinal flora community structure in group A was different from that in group B,Adonis analysis showed the difference in the bacterial community structure between group A and group B was statistically significant(R2=0.044,P=0.005).PCoA analysis showed,differences in intestinal flora community structure between each of the group A1,group A2 and group B,Adonis analysis showed the difference in the bacterial community structure between group A1 and group B was statistically significant(R2=0.086,P=0.006),the difference in the bacterial community structure between group A2 and group B was statistically significant(R2=0.061,P=0.006),the difference in the bacterial community structure between group A1 and group A2 was statistically significant(R2=0.043,P=0.045).6.LEfSe analysis showed,compared group A and group B,in group A,the microorganisms of Blautia,Chryseobacterium,Agathobacter and Roseburia were significantly reduced,and the microorganisms of Megamonas and Enterococcus were significantly increased(LDA>4.0);compared group A1 and group A2,the microorganisms of Christensenella and Bacteroides increased significantly in group A1,the microorganisms of Lactobacillus and Rothia increased significantly in group A2(LDA>4.0).7.Spearman correlation analysis showed,the absolute count of total lymphocytes was positively correlated with the number of Weissella(r=0.329,P=0.046),the absolute count of T lymphocytes was positively correlated with the number of Weissella(r=0.352,P=0.033),the absolute count of helper T lymphocytes was positively correlated with the number of Weissella(r=0.346,P=0.036);fecal calprotectin was positively correlated with the number of Megamonas(r=0.383,P=0.007).Conclusions1.Intestinal flora disorders in children with Henoch-Schonlein purpura,manifested as reduction of beneficial bacteria producing butyrate in the intestinal flora,and more opportunistic pathogens,intestinal flora disorders might be related to the occurrence of Henoch-Schonlein purpura.2.In the early stage of the disease,the intestinal flora of children with Henoch-Schonlein purpura nephritis had been different from children with Henoch-Schonlein purpura without kidney injury,disorders of the intestinal flora in the early stages of the disease might be related to the occurrence of Henoch-Schonlein purpura nephritis.3.Lymphocyte subsets and fecal calprotectin were related to intestinal flora,they might interact and participate in the process of occurrence and development of Henoch-Schonlein purpura.