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目的考察T和B淋巴细胞活性与过敏性紫癜发病机制。方法通过检测过敏性紫癜患儿外周血T细胞亚群、滤泡辅助性T细胞及相关细胞因子、体液免疫水平,比较急性期和缓解期的变化,以及维生素D对其变化的影响。过敏性紫癜患儿45例,随机分为2组:过敏性紫癜组,给予抗过敏治疗;过敏性紫癜+维生素D组,一般治疗同过敏性紫癜组,同时加用维生素D治疗。急性期及缓解期采血,流式细胞术检测外周血T淋巴细胞亚群、CXCR5+ICOS+CD4+T细胞(滤泡辅助性T细胞),ELISA测定血浆中滤泡辅助性T细胞相关细胞因子白细胞介素-21(IL-21)、趋化因子配体13(CXCL13)水平。速率散射比浊法检测外周血免疫球蛋白IgG、IgM、IgA、IgE、C3、C4水平。20例相配健康儿童作为正常对照组。结果与正常对照组相比,过敏性紫癜组及过敏性紫癜+维生素D组急性期CD4+T、NK细胞数降低,而CD19细胞、滤泡辅助性T细胞百分率、IL-21、CXCL13、IgG、IgA、IgE水平升高;过敏性紫癜组缓解期CD4+T、NK细胞降低,滤泡辅助性T细胞百分率、IL-21水平升高。维生素D治疗可降低过敏性紫癜患儿的CD19、滤泡辅助性T细胞百分率、IL-21、CXCL13水平,增加同组患儿的NK细胞,并降低同组患儿的CD19、滤泡辅助性T细胞百分率、IL-21、CXCL13、IgG、IgE水平。结论细胞及体液免疫参与过敏性紫癜发病,维生素D治疗可改善免疫细胞,尤其是滤泡辅助性T细胞及相关细胞因子的数量和功能,可能是治疗过敏性紫癜的方法之一。
Objective To investigate the T and B lymphocyte activity and the pathogenesis of allergic purpura. Methods The levels of T lymphocyte subsets, follicular helper T cells and related cytokines, humoral immunity in acute peripheral blood of children with Henoch-Schonlein purpura were detected, and the changes of acute and remission period and the effect of vitamin D on the changes were analyzed. Children with Henoch-Schonlein purpura 45 cases were randomly divided into two groups: allergic purpura group, giving anti-allergic treatment; allergic purpura + vitamin D group, the general treatment with allergic purpura group, plus vitamin D treatment. Acute and remission blood sampling, peripheral blood T lymphocyte subsets, CXCR5 + ICOS + CD4 + T cells (follicle-supporting T cells) were detected by flow cytometry. The levels of follicular helper T cell-associated cytokines Interleukin-21 (IL-21), chemokine ligand 13 (CXCL13) levels. The rate of peripheral blood immunoglobulin IgG, IgM, IgA, IgE, C3, C4 was detected by rate nephelometry. Twenty healthy children as normal control group. Results Compared with the normal control group, the numbers of CD4 + T and NK cells in the allergic purpura group and the allergic purpura + vitamin D group were lower than those in the normal control group, while the percentage of CD19, follicular helper T cells, IL-21, CXCL13, IgG , IgA, IgE levels; allergic purpura remission CD4 + T, NK cells decreased, the percentage of follicular helper T cells, IL-21 levels. Vitamin D treatment can reduce the children with Henoch-Schonlein purpura CD19, follicular helper T cell percentage, IL-21, CXCL13 levels, increase the same group of children’s NK cells, and reduce the same group of children with CD19, follicular helper T cell percentage, IL-21, CXCL13, IgG, IgE levels. Conclusion Cell and humoral immunity are involved in the pathogenesis of anaphylactoid purpura. Vitamin D treatment can improve the number and function of immune cells, especially follicular helper T cells and related cytokines, and may be one of the methods for the treatment of Henoch-Schonlein purpura.