趋化因子受体CCR3、CCR5在过敏性紫癜患儿中的表达及复方甘草酸苷对其的影响

发布时间：2018-04-11 15:06

本文选题：复方甘草酸苷 + 过敏性紫癜　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:过敏性紫癜(HSP)是一种儿童期多见的全身性小血管炎,病因复杂,主要临床表现为双下肢为主的特征性皮疹,高出皮面,压之不退色,多伴有消化道、关节和肾脏等多系统损害,如不及时治疗,病情加重可出现消化道出血、肠套叠、失血性休克、肾功能衰竭等严重并发症,危及患儿的生命安全。其病程数日至数年不等,近期预后与消化道症状有关,长期预后取决于其肾损害的严重程度[1,2],一般预后良好。目前其致病机制尚不明确[3-5],亦无特效的治疗方法。许多研究表明,T细胞亚群的功能失衡极大可能参与了其发病机制。本文旨在通过观察复方甘草酸苷治疗过敏性紫癜的临床效果和不良反应,并测定趋化因子受体CCR3、CCR5水平的变化,探讨过敏性紫癜的发病机制以及证实复方甘草酸苷治疗过敏性紫癜(HSP)的疗效。方法:选取收治的40例过敏性紫癜患儿,根据就治顺序编号,采取随机数字表法分为2组,即对照组和治疗组,每组各20例,给予对照组常规治疗,治疗8天。治疗组则在常规治疗的基础上使用复方甘草酸苷(1~2mg/kg.d,最大量2mg/kg.d,不超过20mg),一天一次,治疗8天。此外筛选同时期20例健康体检儿童作为健康组。通过流式细胞仪测定健康组及紫癜组(对照组和治疗组)治疗前后的趋化因子受体CCR3、CCR5水平,并记录治疗组和对照组各自的临床症状缓解(消退)时间,观察有无不良反应。结果:1、临床疗效:治疗组显著优于对照组,经统计学比较,p0.05,存在明显差异。2、临床症状缓解(消退)时间:治疗组短于对照组,差异有统计学意义(p0.05)。3、紫癜组与健康组比较,CCR3水平明显升高,CCR5水平明显下降,比较均存在极大差异(p0.05)。4、紫癜组治疗前后比较,治疗后CCR3水平降低,CCR5水平升高,比较有统计学意义(p0.05),治疗组差异大于对照组。5、两组在治疗中及治疗后均未见不良反应。结论:1、相比于健康组,HSP患儿CCR3水平升高,CCR5水平降低,说明HSP患儿体内存在Th1/Th2失衡,Th2优势表达。2、治疗后紫癜组,CCR3水平降低,CCR5水平升高,治疗组差异显著,复方甘草酸苷对HSP的作用机制可能通过下调CCR3表达,上调CCR5表达来调节Th1/Th2失衡,从而发挥免疫调节作用。3、复方甘草酸苷治疗HSP疗效显著,副作用少。
[Abstract]:Objective: Henoch-Schonlein purpura (HSP) is a common systemic vasculitis in childhood with complicated etiology.Severe complications such as gastrointestinal bleeding intussusception hemorrhagic shock renal failure and other serious complications such as joint and kidney damage such as failure to treat the disease in time may lead to serious complications such as gastrointestinal bleeding intussusception hemorrhagic shock renal failure and so on which endanger the life and safety of children.The course of disease varies from several days to several years. The short-term prognosis is related to the symptoms of digestive tract. The long-term prognosis depends on the severity of renal damage, and the general prognosis is good.At present, the pathogenesis of the disease is not clear [3-5], and there is no effective treatment.Many studies have shown that the functional imbalance of T cell subsets may be involved in its pathogenesis.The aim of this study was to observe the clinical effects and adverse reactions of compound glycyrrhizin in the treatment of Henoch-Schonlein purpura, and to determine the level of CCR3 and CCR5, a chemokine receptor, in the treatment of allergic purpura.To investigate the pathogenesis of Henoch-Schonlein purpura and the efficacy of compound glycyrrhizin in the treatment of Henoch-Schonlein purpura.Methods: 40 children with Henoch-Schonlein purpura were randomly divided into two groups: control group (n = 20) and treatment group (n = 20).The treatment group was treated with compound glycyrrhizin 1 2 mg / kg 路d, with a maximum dose of 2 mg / kg 路d, no more than 20 mg / d, once a day for 8 days.In addition, 20 healthy children in the same period were selected as healthy group.The levels of CCR3- CCR5, a chemokine receptor, were measured by flow cytometry before and after treatment in the healthy group and the purpura group (control group and treatment group). The time of remission (regression) of clinical symptoms was recorded in the treatment group and the control group, and the adverse reactions were observed.Results: the clinical effect: the treatment group was significantly better than the control group (P 0.05), there was a significant difference between the two groups. The clinical symptom relief time was shorter in the treatment group than that in the control group.The level of CCR3 in the purpura group was significantly higher than that in the healthy group, and the level of CCR5 was significantly lower than that in the healthy group, and there was a great difference between the two groups. The level of CCR3 in the purpura group was lower than that in the control group before and after treatment, and the level of CCR5 was increased after treatment.The difference between the treatment group and the control group was higher than that in the control group. There were no adverse reactions in the treatment group and after treatment.Conclusion compared with the healthy control group, the level of CCR3 increased and the level of CCR5 decreased in the control group, indicating that there was a predominance expression of Th _ 2 in the patients with HSP, and the level of CCR3 decreased after treatment in the Henoch-Schonlein purpura group, and the difference between the treatment group and the treatment group was significant.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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