摘要
目的 探讨儿童过敏性紫癜(HSP)血清25-羟维生素D[25(OH)D]与肾功能、免疫功能的关系.方法 329例HSP患儿据血清25(OH)D水平分为维生素D缺乏组(n=137)、维生素D不足组(n=117)及维生素D充足组(n=75),收集各组患儿的一般情况(年龄、性别、临床分型),抽取各组HSP患儿禁食4 h及以上静脉血,采用全自动生化免疫分析仪检测血清25(OH)D、尿素、尿素/肌酐、血尿酸、血清胱抑素C、肾小球滤过率的水平,采用苦味酸法及免疫比浊法检测血肌酐及24 h尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿蛋白免疫球蛋白G(IgG)、尿α1微球蛋白,采用流式细胞仪检测总T淋巴(T)细胞、CD8+T细胞、CD4+T细胞、自然杀伤(NK)细胞及B细胞水平,并计算淋巴细胞各亚群的百分比;采用全自动蛋白分析仪检测血清中免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、IgG、补体C3(C3)及补体C4(C4)水平;采用Pearson和Spearman分析HSP患儿血清25(OH)D水平与上述指标之间的相关性.结果 维生素D缺乏组患儿肾型占比高于维生素D不足组、维生素D充足组,差异有统计学意义(P<0.05);维生素D缺乏组24 h尿蛋白定量、尿微量白蛋白、尿转铁蛋白、尿蛋白IgG、尿α1微球蛋白、血肌酐、CD8+T细胞比例高于维生素D充足组,尿素/肌酐、肾小球滤过率、IgG、NK细胞比例低于维生素D充足组,差异有统计学意义(P<0.05);HSP患儿血清25(OH)D水平与肾小球滤过率、IgG、NK细胞比例呈正相关(P<0.05),与24 h尿蛋白定量、血肌酐、胱抑素C、IgA、CD8+T细胞比例呈负相关(P<0.05).结论 血清25(OH)D水平降低可能会导致HSP患儿肾损害和免疫功能紊乱的发生.
Abstract
Objective To explore the relationship between serum 25-hydroxyvitamin D[25(OH) D],renal function and immune function in children with Henoch-Schonlein purpura ( HSP ) . Methods A total of 329 children with HSP were categorized into vitamin D deficiency group (n=137 ),vitamin D insufficiency group ( n=117 ),and vitamin D sufficiency group ( n=75 ) according to their serum 25 ( OH) D levels. General information ( age,gender,clinical typing) of children in each group were collected. Venous blood was collected from children with HSP in each group after fasting for 4 hours or more. An automated biochemical immunoassay analyzer was used to measure the levels of serum 25 ( OH ) D,urea,urea/creatinine,serum uric acid,cystatin C and glomerular filtration rate. Picric acid and immunoturbidimetric methods were applied to determine serum creatinine and 24 h urine total protein quantitation,urinary microalbumin,urinary transferrin,urinary protein immunoglobulin G ( IgG) and urinary α1-microglobulin. Flow cytometry was applied to measure the percentages of total lymphocytes ( T) cells,CD8+T cells,CD4+T cells,natural killer ( NK) cells and B cells. An automatic proteins analyzer was used to detect the levels of IgA,IgM,IgG,complement C3 ( C3 ) and C4 . Pearson and Spearman correlations were analyzed between serum 25 (OH)D levels and the above indexes in children with HSP. Results The proportion of renal type in vitamin D deficiency group was higher than that in vitamin D deficiency and vitamin D adequacy groups (P<0.05). 24 h urine total protein quantitation,urinary microalbumin,urinary transferrin,urinary immunoglobulin G,urinary α1-microglobulin,serum creatinine and the proportion of CD8+T cells were higher in vitamin D deficiency group than those in vitamin D sufficiency group,while urea/creatinine,glomerular filtration rate,IgG and the proportion of NK cells were lower than those in vitamin D sufficiency group (P<0.05). Serum 25(OH)D levels in children with HSP were positively correlated with glomerular filtration rate,IgG and the proportion of NK cells (P<0.05),and negatively correlated with 24 h urine total protein quantitation,serum creatinine,cystatin C,IgA,and the proportion of CD8+T cells (P<0.05). Conclusion Reduced serum 25(OH)D levels might lead to the development of renal damage and immune dysfunction in children with HSP.
基金项目
贵州省科技计划项目(黔科合平台人才[2019]5406)
贵州省卫生健康委科学技术基金(gzwjkj2019-1-002)
维普
万方数据