文章摘要

过敏性紫癜患儿血清胱抑素C和血栓调节蛋白与T淋巴细胞亚群的相关性研究

作者: 1赵 丽丽, 1丁 显春, 1陈 芳, 1赵 静丽, 1牛 文忠
1 南阳市中心医院小儿内科,河南 南阳 473009
通讯: 丁 显春 Email: 6742158923@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.04.011

摘要

目的:探讨过敏性紫癜(Henoch-Schonlein purpura,HSP)患儿血清中胱抑素C(cystatin C,CysC)、血栓调节蛋白(thrombomodulin protein,TM)与T淋巴细胞亚群的相关性及各指标的诊断价值。方法:选取2017年2月至2019年5月于南阳市中心医院接受治疗的HSP患儿127例作为观察组,同期在南阳市中心医院进行体检的健康儿童68例作为对照组。采用免疫比浊法测定两组儿童血清中CysC水平,酶联免疫吸附法测定TM水平,流式细胞术检测T淋巴细胞亚群;Pearson分析CysC,TM与T淋巴细胞亚群的相关性;ROC曲线用于评估CysC,TM及T淋巴细胞亚群对HSP患儿的预测价值;Logistic回归分析HSP患儿的易感因素。结果:HSP患儿血清中CysC,TM,CD8+水平均升高,CD3+,CD4+水平以及CD4+/CD8+比值均降低,与对照组相比,差异均有统计学意义(P<0.05)。HSP患儿血清中CysC和TM均与CD3+,CD4+以及CD4+/CD8+比值呈负相关(均P<0.05),与CD8+呈正相关(均P<0.05)。ROC曲线分析显示:CD4+/CD8+比值曲线下面积(AUC)最大,之后依次为CysC,TM,CD4+和CD8+,而CD3+ AUC最小,同时辨别了各指标的临界值,灵敏性和特异性均较高,CysC+TM+T淋巴细胞亚群三者联合AUC为0.918,灵敏度为93.5%,特异度为90.1%。Logistic回归分析结果表明:饮食、感染、药物、运动劳累、空气污染、家庭环境、家族遗传、年龄以及冬春季节均是HSP患儿的易感因素。结论:HSP患儿血清中CysC,TM与T淋巴细胞亚群均有一定的相关性,可通过联合监测血清中CysC,TM及T淋巴细胞亚群水平以提高儿童HSP正确诊断率,同时避免易感因素以减少HSP的发生。
关键词: 过敏性紫癜;胱抑素C;血栓调节蛋白;T淋巴细胞亚群;相关性

Correlation of serum cystatin C and thrombomodulin protein with T lymphocyte subgroup in children with allergic purpura

Authors: 1ZHAO Lili, 1DING Xianchun, 1CHEN Fang, 1ZHAO Jingli, 1NIU Wenzhong
1 Department of Pediatric Internal Medicine, Nanyang City Center Hospital, Nanyang Henan 473009, China

CorrespondingAuthor:DING Xianchun Email: 6742158923@qq.com

Abstract

Objective: To investigate the correlation of serum cystatin C (CysC) and thromboregulatory protein (TM) with T lymphocyte subpopulation in children with allergic purpura (HSP) and the diagnostic value of each index. Methods: A total of 127 children with allergic purpura treated in our hospital from February 2017 to May 2019 were selected as an observation group, and 68 healthy children who underwent physical examination in our hospital during the same period were selected as a control group. Serum CysC levels in the two groups were determined by immunoturbidimetric method, TM levels were determined by ELISA, and T lymphocyte subsets were detected by flow cytometry. The correlation between CysC, TM and T lymphocyte subsets was analyzed by Pearson. ROC curve was used to evaluate the predictive value of CysC, TM and T lymphocyte subsets in children with HSP. Logistic regression analysis of susceptibility factors in children with allergic purpura. Results: The serum levels of CysC, TM and CD8+ in HSP children all increased, and the levels of CD3+, CD4+ and CD4+/CD8+ all decreased, which were statistically significant compared with the control group (P<0.05). Serum CysC and TM of HSP children were significantly negatively correlated with CD3+, CD4+ and CD4+/CD8+ ratios (all P<0.05), and significantly positively correlated with CD8+ (all P<0.05). ROC curve analysis showed that the area under curve (AUC) of CD4+/CD8+ ratio was the largest, followed by CysC, TM, CD4+ and CD8+, while the AUC of CD3+ was the smallest. The combined AUC of CysC+TM+T lymphocyte subsets was 0.918, the sensitivity was 93.5%, and the specificity was 90.1%. At the same time, the critical value of each indicator was identified, indicating high sensitivity and specificity. Logistic regression analysis results showed that diet, infection, drugs, exercise fatigue, air pollution, family environment, family heredity, age, and winter and spring seasons were all susceptible factors for HSP children. Conclusion: CysC, TM and T lymphocyte subsets in serum of children with HSP are correlated to some extent, and the correct diagnosis rate of HSP in children can be improved by monitoring the levels of CysC, TM and T lymphocyte subsets in serum together, and the occurrence of HSP could be reduced by avoiding susceptibility factors.
Keywords: Henoch-Schonlein purpura; cystatin C; thromboregulatory protein; T lymphocyte subpopulation; correlation