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目的观察IgA肾病(IgAN)患儿初始B淋巴细胞在滤泡辅助性T淋巴细胞(Tfh)相关因子作用下的诱导成熟过程,探讨半乳糖缺乏的IgA1(Gd-IgA1)的诱生及其临床意义。方法随机选择IgAN患儿及健康儿童各8例。磁珠分选外周血初始B淋巴细胞(CD27-IgD+),加IL-21和转化生长因子-β1等细胞因子共培养,测定细胞培养上清液J链的表达、IgA水平、Gd-IgA1水平;并分别测定外周血单个核细胞J链的表达及血清IgA、Gd-IgA1水平。结果 IgAN组和健康对照组细胞培养上清液及外周血单个核细胞J链的表达相对值比较差异无统计学意义(Pa>0.05),上清液IgA分泌及血清IgA水平比较差异亦无统计学意义(P>0.05)。与对照组比较,IgAN组细胞培养上清液及血清Gd-IgA1水平均明显升高,差异均有统计学意义(P<0.01,0.05)。结论 IgAN患儿外周血初始B淋巴细胞可分化成熟产生Gd-IgA1。Tfh细胞及相关细胞因子在诱生B淋巴细胞成为分泌型IgA的浆母细胞及分泌Gd-IgA1过程中起关键的调节作用。血清Gd-IgA1可能是间接反映IgAN的无创性指标之一。
Objective To observe the induction and maturation of primary B lymphocytes in children with IgA nephropathy (IgAN) under the follicular-assisted T lymphocyte (Tfh) -related factors and to investigate the induction of galactose-deficient IgA1 (Gd-IgA1) significance. Methods Eight children with IgAN and 8 healthy children were randomly selected. The expression of J chain, IgA and Gd-IgA1 in the supernatant of the cell culture were determined by magnetic beads sorting of the peripheral blood of the initial B lymphocytes (CD27-IgD +), plus IL-21 and transforming growth factor-β1 and other cytokines The expression of J chain and the levels of IgA and Gd-IgA1 in peripheral blood mononuclear cells were measured respectively. Results There was no significant difference in the relative expression of J chain between supernatant and peripheral blood mononuclear cells in IgAN group and healthy control group (Pa> 0.05), but there was no statistical difference in IgA secretion between supernatant and serum IgA Significance (P> 0.05). Compared with the control group, IgAN group cell serum supernatant and serum Gd-IgA1 levels were significantly increased, the differences were statistically significant (P <0.01, 0.05). Conclusion The initial B lymphocytes from IgAN children can differentiate and mature to produce Gd-IgA1. Tfh cells and related cytokines play a key regulatory role in inducing B lymphocytes to become secreted IgA plasmablasts and secreting Gd-IgA1. Serum Gd-IgA1 may be indirect non-invasive IgAN one of the indicators.