匹多莫德对儿童过敏性紫癜 Th17／Treg 细胞免疫的影响

摘要

Objective To observe and analyze the effects of pidotimod on the immunity of Treg/Th17 cells in the children with Henoch-Schonlein purpura (HSP).Methods 60 cases of HSP were selected and randomly divided into the pidotimod treatment group and the conventional treatment group,30 cases in each group.30 healthy children were selected as the control group.The con-ventional treatment group was given the routine therapy,while the pidotimod treatment group was added with oral pidotimod dis-persible tablets on the basis of the routine therapy.The ratios of Treg cell subsets and Th17 cell subsets,the plasma expression lev-els of interleukin-17 (IL-17),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)and interferon inducible protein-10 (IP-10) among 3 groups and the time for rash relief,remission rate of hematuria and proteinuria,recurrence rate within 1 month in HSP children were observed and compared.Results The ratios of Treg cell subsets and Th17 cell subsets after treatment had no statisti-cal difference between the pidotimod treatment group and the control group(P >0.05),while which had the statistical difference be-tween the conventional treatment group and the control group(P <0.05 );the plasma IL-17,IFN-γ,IP-10 and TNF-α expression levels had no statistical differences between the pidotimod treatment group and the control group(P >0.05),but the IL-17 and IFN-γexpression levels in the conventional treatment group were still significantly higher than those in the control group.the remission rate of simple hematuria in the pidotimod treatment group was significantly higher than that in the conventional treatment group, while the recurrence rate within 1 month after treatment was significantly lower than that in the conventional treatment group.Con-clusion The application of pidotimod therapy in the treatment of children with HSP can significantly correct the imbalance of Treg cell subsets and Th17 cell subset,decrease the expression levels of the cytokines such as IL-17 and IFN-γ,suppress the autoimmune reaction so as to achieve the effects of significantly alleviating the impairment of renal function and reducing the short term recur-rence rate,which is benefit for the improvement of prognosis in the children patients with HSP.%目的：了解匹多莫德对儿童过敏性紫癜（HSP）正辅助性 T 细胞17（Th17）与调节性 T 细胞（Treg）免疫的影响。方法选取60例 HSP 患儿，将其随机分为匹多莫德治疗组和常规治疗组，每组各30例，选取30例健康儿童作为对照组。常规治疗组患儿给予常规治疗，匹多莫德治疗组患儿在常规治疗的基础上加用口服匹多莫德分散片治疗。对3组儿童的 Treg 细胞亚群和 Th17细胞亚群比例，血浆白细胞介素17（IL-17）、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、干扰素诱导蛋白-10（IP-10）表达水平及 HSP 患儿的皮疹缓解时间、血尿和蛋白尿缓解率、治疗1月内皮疹复发率进行检测和比较。结果经治疗，匹多莫德治疗组的 Treg 细胞亚群和 Th17细胞亚群比例与对照组的差异均无统计学意义（P ＞0．05），而常规治疗组患儿的 Treg 细胞亚群和Th17细胞亚群比例与对照组的差异有统计学意义（P ＜0．05），匹多莫德治疗组患儿的血浆 IL-17、IFN-γ、IP-10、TNF-α表达水平与对照组的差异均无统计学意义（P ＞0．05），而常规治疗组患儿的 IL-17、IFN-γ表达水平仍然显著高于对照组，匹多莫德治疗组患儿的单纯血尿缓解率显著高于常规治疗组，治疗1月内复发率显著低于常规治疗组。结论应用匹多莫德治疗儿童 HSP，可纠正患儿机体内 Treg 细胞亚群和 Th17细胞亚群功能的失衡，降低 IL-17、IFN-γ等的表达水平，抑制自身免疫反应，可达到显著缓解肾功能损伤、降低短期复发率的效果，有利于改善患儿的预后。