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重庆医科大学附属儿童医院肾脏免疫科、儿童发育疾病研究教育部重点实验室、儿科学重庆市重点实验室、重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆,400014
纸质出版日期:2014,
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黄应波, 唐雪梅, 张 宇, 等. 复方甘草酸苷对儿童过敏性紫癜Th17/Treg细胞免疫的影响[J]. 重庆医科大学学报, 2014,38(7):990-994.
Huang Yingbo, Tang Xuemei, Zhang Yu, et al. Effect of compound glycyrrhizin on Th17/Treg cells in children with Henoch-Schonlein purpura[J]. Journal of Chongqing Medical University, 2014,38(7):990-994.
目的:探讨复方甘草酸苷(compound glycyrrhizin,GL)治疗儿童过敏性紫癜(Henoch-Schonlein purpura,HSP)的临床疗效,从Treg、Th17细胞及促炎因子方面探讨其免疫学机制。方法:27例初发HSP病人作为治疗组,26例作为疾病对照组,25例健康儿童作为正常对照组。治疗组在疾病对照组的基础上增加GL(0.5~2.0 ml/kg)静脉注射7 d治疗;留取治疗前后全血PBMC行流式检测Treg、Th17细胞阳性率,血浆ELISA法检测促炎因子TNF-α,干扰素诱导蛋白-10(interferon inducible protein-10,IP-10),白介素17(interleukin-17,IL-17),干扰素-γ(interferon-γ,IFN-γ)浓度变化。结果:①临床症状:治疗组皮疹消退时间较疾病对照组有缩短趋势,肾损害有缓解,1月内紫癜复发率低;②Treg、Th17细胞比例:治疗组治疗前Treg细胞阳性率低于正常对照组(P=0.010);治疗后与正常对照组无统计学差异(P=0.059);疾病对照组治疗后Treg低于治疗前及正常对照组(P=0.006,P=0.013)。治疗组治疗前Th17细胞阳性率高于治疗后及正常对照组水平(P=0.024,P=0.013);治疗后Th17与正常对照组无统计学差异(P=0.337)。疾病对照组治疗前Th17亦明显高于治疗后水平(P=0.014)。③炎症因子:2组HSP治疗前血浆IL-17,IFN-γ浓度均高于正常对照组水平(P=0.013,P=0.010);治疗组治疗后与正常对照组无统计学差异(P=0.052,P=0.154),疾病对照组两指标治疗前后比较无统计学差异(P=0.218,P=0.970)。治疗组治疗前血浆TNF-α、IP-10均高于治疗后(P=0.011,P=0.037),疾病对照组治疗前后2指标无统计学差异(P=0.247,P=0.709)。结论:①GL治疗儿童HSP,可减轻肾损害、短期内减少紫癜复发。②HSP患儿急性期,具有促炎作用的Th17和抗炎作用的Treg可能共同参与了其免疫发病。③GL具有下调Th17、上调Treg细胞比例,降低血浆IL-17、IFN-γ、TNF-α、IP-10水平的作用,提示GL可能具有一定T细胞免疫调节功能,在佐治儿童HSP免疫炎症方面有一定疗效。
Objective:To investigate the role of Th17/Treg and some cytokines imbalance in the pathogenesis of childhood Henoch-Schonlein purpura(HSP) and to further explore the clinical effectiveness and immunomodulatory effects of compound glycyrrhizin(GL) in HSP. Methods:Twenty-seven HSP patients were chose as GL-treated group,another 26 patients were used as conventional therapy group,and 25 age-and sex-matched healthy children were used as healthy controls. Intravenous injection of 0.5-2.0 ml/kg GL for 7 days was provided in GL-treated group on the basis of treatments in conventional therapy group. Blood samples of patients were ob-tained at the acute stage and after 7 days’ treatment.Postive cell rates of peripheral Th17 and Treg cells were detected by flow cytom-etry using intracellular staining. Serum levels of interleukin-17,interferon-γ,TNF-α,interferon inducible protein-10 were detected by ELISA. Results:①Clinical effectiveness:renal complications in GL-treated group were relieved and recurrence of HSP within 1 month was lower. ②Positive cell rate of Treg and Th17 cell:compared with that of healthy controls,the positive cell rate of Treg in GL-treated group was significantly down-regulated during acute phase(P=0.010) and was up-regulated after the treatment(P=0.059). In conventional therapy group,positive cell rate of Treg was lower after the treatment compared with that before treatment and that of healthy control group(P=0.006,P=0.013). The positive cell rate of Th17 in GL-treated group was significantly higher before the treat-ment compared with that after the treatment and that of conven-tional therapy group(P=0.024,P=0.013). After the treatment,there was no difference in the positive cell rate of Th17 between GL-treated group and conventional therapy group(P=0.337). The positive cell rate of Th17 in conventional therapy group was significantly higher before the treatment compared with that after the treatment(P=0.014). ③Cytokines:Serum levels of IL-17 and IFN-γ were higher in GL-treated group and conventional therapy group than in healthy control group before the treatment(P=0.013,P=0.010). There was no difference in serum levels of IL-17 and IFN-γ between GL-treated group after the treatment and healty control group(P=0.052,P=0.154). There was no difference in serum levels of IL-17 and IFN-γ in conventional therapy group before and after the treatment(P=0.218,P=0.970). Serum levels of TNF-α and IP-10 in GL-treated group were down-regulated after the treatment(P=0.011,P=0.037). But no difference was detected in conventional therapy group before and after the treatment(P=0.247,P=0.709). Conclusion:①GL could relieve the renal complications and decrease recurrence of HSP in a short period of time. ②Treg and Th17 might in part contribute to the process of HSP. ③GL could help to up-regulate Treg and down-regulate Th17,IL-17,IFN-γ,TNF-α,IP-10 level,thus regulating the Th17/Treg deviation and cytokine im-balance and alleviating cellular immunity in HSP.
过敏性紫癜复方甘草酸苷Th17/Treg促炎因子
Henoch-Schonlein purpuracompound glycyrrhizinTh17/Tregcytokines
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