复方甘草酸苷佐治儿童过敏性紫癜及其细胞免疫机制探讨

发布时间：2018-06-06 20:37

本文选题：过敏性紫癜 + 复方甘草酸苷　；参考：《重庆医科大学》2014年硕士论文

【摘要】：第一部分复方甘草酸苷对儿童过敏性紫癜Th17/Treg细胞免疫的影响目的：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，以及对外周血Treg、Th17细胞免疫的影响。方法：采集我院肾脏免疫科住院治疗的27例初发HSP病人作为治疗组，另26例HSP患儿作为疾病对照组；于儿童保健门诊收集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复方甘草酸苷(0.5-2ml/kg)iv*7天治疗；留取治疗前后外周血单个核细胞行流式细胞术检测Treg、Th17细胞阳性率。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，，且肾损害有缓解，1月内紫癜复发率低；2.Treg、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与正常对照组无差异(P=0.337)。疾病对照组治疗前Th17亦显著高于治疗后水平(P=0.014)。结论：1.GL治疗儿童HSP，可减轻肾损害、短期内减少紫癜复发。2.HSP患儿急性期，具有促炎作用的Th17和抗炎作用的Treg可能共同参与其免疫发病。3.GL具有下调Th17、上调Treg细胞比例的作用，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。第二部分复方甘草酸苷对儿童过敏性紫癜血浆IL-17、TNF-α、IP-10、IFN-γ水平的影响目的：从促炎因子IL-17、TNF-α、IP-10、IFN-γ水平探讨复方甘草酸苷(compound glycyrrhizin， GL)治疗儿童过敏性紫癜(Henoch-Schonlein purpura, HSP)的免疫学机制。方法：采集我院肾脏免疫科住院治疗的27例初发HSP病人作为治疗组，另26例HSP患儿作为疾病对照组；同时于儿童保健门诊收集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复方甘草酸苷(0.5-2ml/kg)iv*7天治疗；ELISA法检测患儿血浆中促炎因子TNF-α、IP-10、IL-17、IFN-γ的浓度变化。结果：1.两组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IL-17、IFN-γ浓度与正常对照组无统计学差异(P=0.052，P=0.154)，疾病对照组治疗后仍显著高于正常对照组(P=0.000，P=0.000)。2.治疗组治疗前血浆TNF-α、IP-10均高于治疗后水平(P=0.011，P=0.037)，疾病对照组治疗前后两指标无统计学差异(P=0.247，P=0.709)。结论：GL具有降低HSP患儿血浆IL-17、IFN-γ、TNF-α、IP-10水平的作用，在佐治儿童HSP免疫炎症方面有一定疗效。
[Abstract]:Part one the effect of compound glycyrrhizin on Th17 / Treg cell immunity in children with Henoch-Schonlein purpura (HSP). Objective: to investigate the clinical effect of compound glycyrrhizin GLL on Henoch-Schonlein purpura (HSPs) in children with Henoch-Schonlein purpura (HSP). Methods: 27 patients with primary HSP were selected as treatment group and 26 children with HSP as control group. 25 healthy children were collected as normal control group. The patients in the treatment group were treated with compound glycyrrhizin 0.5-2ml / kg iv for 7 days, and the positive rate of TregTh17 cells was detected by flow cytometry before and after the treatment. Clinical symptoms: in treatment group, the time of rash subsiding was shorter than that in control group. The renal damage was alleviated and the recurrence rate of purpura was low within 1 month. 2. Proportion of Tregg Th17 cells: the positive rate of Treg cells in the treatment group was lower than that in the normal control group before treatment, the positive rate of Treg cells in the treatment group was lower than that in the normal control group, there was no statistical difference between the treatment group and the normal control group, and the Treg level in the disease control group was lower than that in the control group after treatment. Before treatment and normal control group, P0. 006 and P0. 013. The positive rate of Th17 cells in treatment group was higher than that after treatment and normal control group, but there was no difference between Th17 and normal control group after treatment. Th17 was also significantly higher in the disease control group before and after treatment than that in the post-treatment group. Conclusion the treatment of children with HSP1 / GL can reduce renal damage and decrease the recurrence of Henoch-Schonlein purpura at the acute stage of HSP in a short period of time. Th17 with proinflammatory effect and Treg with anti-inflammatory action may be involved in its immunopathogenesis. 3.GL can down-regulate Th17 and up-regulate the proportion of Treg cells, suggesting that GL may have the function of T cell immunomodulation. Part 2 effect of compound glycyrrhizin on plasma IL-17 TNF- 伪 IP-10 IFN- 纬 level in children with allergic purpura: objective: to explore the effect of compound glycyrrhizin (GLL) on the level of IL-17 TNF- 伪 IP-10 IFN- 纬 in children with HSP. The immunological mechanism of Henoch-Schonlein purpura (HSP) in children with Henoch-Schonlein purpura (HSP). Another 26 children with HSP served as disease control group and 25 healthy children as normal control group. In the treatment group, the concentration of TNF- 伪, IP-10, IL-17 and IFN- 纬 in plasma was detected by Elisa on the basis of adding compound glycyrrhizin 0.5-2ml / kg iv for 7 days. Before and after treatment, the plasma levels of IL-17 and IFN- 纬 in the two groups were higher than those in the normal control group, but there was no significant difference between the treatment group and the normal control group in the concentration of IL-17, IFN- 纬, and the level of IL-17, IFN- 纬 in the treatment group was still significantly higher than that in the normal control group after treatment, and there was no significant difference between the treatment group and the normal control group in the level of IL-17 and IFN- 纬. After treatment, the level of IL-17 was still significantly higher than that in the normal control group. The plasma levels of TNF- 伪 and IP-10 before and after treatment were higher in the treatment group than in the post-treatment group, and there was no significant difference between the two indexes before and after treatment in the disease control group. Conclusion the level of IL-17- IFN- 纬 TNF- 伪 IP-10 in plasma of children with HSP can be reduced by the use of TNF- 伪-10 in the treatment group, and there is a certain therapeutic effect in the adjuvant treatment of HSP- immune inflammation in children with HSP.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.5

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