Study On Cellular Immunity And B7-1 Level In Children With Henoch Schonlein Purpura Nephritis

Objective:Henoch Schonlein Pura(HSP)is a kind of vasculitis with leukocyte fragmentation.This kind of vasculitis disease is caused by the deposition of Ig A immune complex in the systemic small blood vessels,also known as Ig A vasculitis.Its clinical features are mainly non thrombocytopenic,palpable skin purpura,arthralgia(or arthritis),gastrointestinal tract and kidney involvement.In recent years,the incidence rate of HSP has been increasing year by year in children.When the kidney involves lesions,it is called Henoch-Schonlein Purpura Nephritis(HSPN).HSPN is a serious complication of HSP,and it is also the most common secondary glomerular disease in childhood.However,its pathogenesis is still unclear,in which T-lymphocyte immune disorder plays an important role.The second signal provided by B7-1/CD28 co stimulator may play a key role in the abnormal immune regulation of T cell immune response.At present,B7-1/CD28 costimulatory molecules play an important role in the pathogenesis of autoimmune diseases,such as systemic lupus erythematosus,nephrotic syndrome,rheumatoid arthritis and so on.At present,there are few reports about B7-1/CD28 costimulatory molecules in the pathogenesis of HSPN.In this study,CD4~+,CD8~+,IL-4,IFN-?and B7-1 in HSP and HSPN were observed to further explore the pathogenesis of HSP and HSPN.Methods:In this study,430 children with Henoch Schonlein purpura who were hospitalized in Dalian children's Hospital from January 2017 to December 2019 were collected.According to their gender,they were divided into 236 males and 194 females,with an average age of 6.98±2.52 years.According to the relevant standards put forward in zhufutang Practical Pediatrics,as the diagnostic standard.In addition to other types of kidney disease,thrombocytopenic purpura and other types of systemic vasculitis,the child was previously in good health and first onset.Meanwhile,30normal children were selected as the control group.430 children with Henoch Schonlein purpura were divided into the following two groups:390 non HSPN group and 40 HSPN group.We analyzed the HSPN group and non HSPN group in turn,and compared the age,gender,repeated rash?3 times,whether there was joint pain or abdominal pain in different groups.We compared the experimental indexes of CD4~+,CD8~+,IFN-?,IL-4,B7-1 in different groups.Spss23.0 statistical software was used for data analysis.According to normal measurement data,two samples t-test was used for comparison between groups,and percentage(%)for counting data.Two tests were used for comparison between groups.Logistic regression model was used for analysis of risk factors,P<0.05 was statistically significant.Result:1.Among 430 children with Henoch Schonlein purpura,236(54.9%)were male,196(45.1%)were female.The ratio of male to female was 1.21:1,and the mean age was 6.98±2.52 years old.Among the 430 children with HSP,40(9.3%)had renal damage.There were 25 males and 15 females.The ratio of males to females was 1.67:1.The average age of the children was 8.5±3.30years old.By 2 tests,age?7 years old was the risk factor of renal damage in HSP children(P<0.05).2.Compared with 390 cases of non HSPN and 40 cases of HSPN,there was a significant difference(P<0.05).3.Taking the occurrence of HSPN as the dependent variable and sex,age,recurrent rash,arthralgia,abdominal pain,arthralgia combined with abdominal pain as the independent variable,multiple logistic regression analysis showed that abdominal pain and age?7 years old were the risk factors of HSPN.According to the single factor analysis and multi factor analysis of HSPN group,age?7 years old was the independent risk factor of kidney injury in HSP children.4.In the clinical classification of 40 children with HSPN,the largest proportion was hematuria with proteinuria(57.5%),and the smallest proportion was nephrotic syndrome(2.5%).There was no significant difference between the gender and age of children with HSPN and the clinical classification of children with HSPN(P>0.05).5.The percentage of CD8~+T lymphocyte in HSPN group was higher than that in non HSPN group(P<0.05),and the difference was statistically significant(P<0.05);the percentage of CD4~+T lymphocyte in HSPN group was lower than that in non HSPN group(P>0.05),and there was no significant difference between HSPN group and non HSPN group(P>0.05),although the percentage of CD4~+T lymphocyte in HSPN group was lower than that in non HSPN group(P<0.05)There was no significant difference between HSPN group and non HSPN group(P>0.05).6.The levels of serum IFN-?and IFN-?/IL-4 in the HSPN group and the non-HSPN group decreased,and the level of IL-4 increased.Compared with the normal control group,the difference was significant(P<0.05).The same difference was significant(P<0.05);the serum B7-1 levels in the HSPN group and the non-HSPN group were reduced.Compared with the normal control group,the difference was statistically significant(P<0.05).The HSPN group was significantly higher than the non-HSPN group,The difference was statistically significant(P<0.05).Conclusion:1.age?7 years is an independent risk factor for renal damage in children with HSP.2.The imbalance of CD4~+T and CD8~+T lymphocytes in children with HSPN indicates that cellular immunity is involved in the pathogenesis of HSPN and HSPN.3.The decrease of IFN-?and the increase of IL-4 in children with HSPN indicate that the imbalance of Th1/Th2 in children with HSPN may be an important cause of kidney involvement in children with HSPN.4.The decrease of serum B7-1 in HSPN suggests that B7/CD28 co stimulatory pathway may be one of the mechanisms of renal damage in HSPN.