【摘要】：目的：過敏性紫癜(Henoch-Schonlein purpura，HSP)是兒童期常見的白細胞碎裂性血管炎。臨床上以非血小板減少性紫癜、關節(jié)腫脹、胃腸道受累和腎炎為主要表現，多見于學齡期，冬春季為發(fā)病高峰期。HSP發(fā)病機理尚未研究透徹，多認為由多因素所致，感染、食物或者藥物等都可作為致敏因素，近年來研究發(fā)現，HSP患者血清中IgA水平升高，血管壁有IgA免疫復合物（IgA-IC）沉積。Th細胞亞群功能失調在其發(fā)病機制中也起著非常重要的作用。 Th1細胞能增強巨噬細胞的吞噬作用，促進細胞免疫；Th2細胞可增強B細胞介導的體液免疫應答。Tim (T cell immunoglobin domain and mucindomain protein)家族因其特殊的結構和表達特異性，可能成為Thl/Th2特異性表面標志之一，參與T細胞的分化及免疫應答調節(jié)：Tim-1細胞主要表達在分化后的Th2細胞上，但在Th1細胞表面幾乎不表達，可誘導Th2活化增殖、促進細胞因子釋放、激發(fā)Th2型免疫應答；Tim-3細胞則特異性表達在分化終末期的Thl細胞上，，負調節(jié)Th1細胞介導的免疫應答。相應地，IL-2作為Th1型細胞因子、IL-4作為Th2型細胞因子，二者含量亦隨之發(fā)生變化。 RT-PCR是一種基于傳統(tǒng)PCR檢測方法上的新技術，同時進行靶序列的擴增與熒光信號的檢測，有效解決傳統(tǒng)PCR定量只能在終點進行檢測和傳統(tǒng)PCR產物的污染問題，具有特異性強，操作簡便，重復性好等優(yōu)點。 本研究通過RT-PCR檢測過敏性紫癜患者外周血單個核細胞(PBMC)中Tim-l、Tim-3mRNA的表達水平，并用ELISA方法檢測外周血中IL-2、IL-4含量，探究Tim家族分子在過敏性紫癜發(fā)生中的作用，進一步闡明過敏性紫癜的發(fā)病機制。 方法：所有的實驗對象均來自河北醫(yī)科大學第二醫(yī)院。病例組28例過敏性紫癜患者，男16例，女12例，平均年齡(19.30士9.58)歲，病程2天-3月。其中19例單純型組（僅有皮疹），9例混合型組（有關節(jié)腫痛、腹痛或蛋白尿中的一項或多項）。對照組為20例健康正常人，經統(tǒng)計學分析，病例組在性別、年齡上與對照組均無統(tǒng)計學差異。抽取研究對象外周靜脈血，采用SYBR Green I RT-PCR技術檢測PBMC中Tim-1mRNA和Tim-3mRNA的表達狀況,并用ELISA方法檢測外周血中IL-2、IL-4含量。 數據采用SPSS13.0軟件進行統(tǒng)計分析。正態(tài)分布數據IL-2、IL-4含量用均數±標準差(x±s)表示，組間比較采用t檢驗；非正態(tài)分布數據Tim-1、Tim-3mRNA表達量RQ值用中位數(四分位間距)[MD(IQR)]表示，組間比較采用Wilcoxon秩和檢驗，P＜0.05認為有統(tǒng)計學意義。 結果: 1過敏性紫癜組與健康對照組Tim-1mRNA相對表達量RQ值分別為0.974（1.108）和0.760（0.514），過敏性紫癜患者Tim-1mRNA的表達水平升高，有顯著性差異（P＜0.05），而在過敏性紫癜患者中單純型組和混合型組之間沒有顯著性差異（P＞0.05）。 2過敏性紫癜組與健康對照組Tim-3mRNA相對表達量RQ值分別為1.359（1.183）和1.604（1.177），兩者無顯著性差異（P＞0.05）。過敏性紫癜患者中單純型組和混合型組之間亦沒有顯著性差異（P＞0.05）。 3過敏性紫癜組與健康對照組IL-2含量分別為188.517±12.867和202.759±20.903（pg/ml），患者組IL-2含量降低，有顯著性差異（P＜0.05），過敏性紫癜組中單純型組和混合型組IL-2含量分別為193.225±11.758和177.531±7.922（pg/ml），兩者之間有顯著性差異（P＜0.05）。 4過敏性紫癜組與健康對照組IL-4含量分別為73.046±8.750和62.301±11.232（pg/ml），患者組IL-4含量升高，有顯著性差異（P0.05），過敏性紫癜中單純型組和混合型組IL-4含量分別為70.400±7.642和79.218±8.591（pg/ml），兩者之間有顯著性差異（P＜0.05）。 結論：本研究提示HSP存在免疫功能紊亂，Th2細胞亞群占優(yōu)勢；Tim1mRNA表達增高，Tim蛋白可能參與HSP發(fā)病，但與疾病嚴重程度和疾病的發(fā)展無相關性；IL-2降低、IL-4升高在混合型組中的變化可能更明顯，提示IL-2、IL-4可能與疾病嚴重程度密切相關。
[Abstract]:Objective: Henoch-Schonlein purpuura (HSP) is a common leucocytic vasculitis in childhood. It is mainly characterized by non-thrombocytopenic purpura, joint swelling, gastrointestinal involvement and nephritis. The pathogenesis of HSP has not been studied thoroughly and many factors, such as infection, food or drug, can be used as a sensitizing factor. In recent years, the level of IgA in the serum of HSP patients is increased, and the blood vessel wall has IgA-IC (IgA-IC) deposition. The dysfunction of Th cell subpopulation plays a very important role in its pathogenesis. Th1 cells can enhance the phagocytosis of macrophages, promote cellular immunity, and Th2 cells can enhance the humoral immunity mediated by B cells. A. Tim (T cell immoglobulin domain and mucin protein) family may be one of the specific surface markers of Thl/ Th2 for its special structure and expression, and it can be involved in the differentiation of T cells and the regulation of immune response: Tim-1 cells are mainly expressed on the differentiated Th2 cells, but the surface of the Th1 cells is almost impossible. up to, the Th2-activated proliferation can be induced, the cytokine release is promoted, the Th2-type immune response is excited, and the Tim-3 cell is specifically expressed on the Thl cell with the end stage of differentiation, and the negative regulation of the Th1 cell-mediated immunity A. As a result, IL-2, as a Th1-type cytokine and IL-4 as a Th2-type cytokine, also changes in the content of IL-2. The RT-PCR is a new technology based on the traditional PCR detection method, and the detection of the target sequence and the detection of the fluorescent signal can be carried out at the same time, so that the detection of the traditional PCR can only be carried out at the end point and the pollution problem of the traditional PCR product is solved, the method has the advantages of strong specificity, simple and convenient operation and good repeatability. The expression level of Tim-l, Tim-3 mRNA in peripheral blood mononuclear cells (PBMC) of patients with Henoch-Schonlein purpura was detected by RT-PCR and the content of IL-2 and IL-4 in peripheral blood was detected by ELISA. The mechanism of the pathogenesis. Methods: All the experimental subjects were from Hebei Medical University. There were 28 cases of allergic purpura,16 males and 12 females, with an average age of 19.30 (9.58). The course of the course was 2 days to 3 months. Of these,19 simple groups (only a rash) and 9 mixed groups (with joint swelling and pain, abdominal pain or proteinuria) One or more of the 20 healthy controls in the control group were statistically analyzed and the case group was in gender, age, and control group The expression of Tim-1 mRNA and Tim-3 mRNA in PBMC was detected by SYBR Green I RT-PCR, and IL-2 in peripheral blood was detected by ELISA. And IL-4 content. The data is SPSS13. The statistical analysis was performed by 0 software. The normal distribution data IL-2, IL-4 content was expressed by mean square standard deviation (x% s), and t-test was used between the groups; the non-normal distribution data, Tim-1, and Tim-3 mRNA expression, were expressed as median (quartile spacing)[MD (IQR)], and Wil was used between the groups. coxon rank sum test, P <0.0 5. Results: The relative expression of Tim-1 mRNA was 0.974 (1.108) and 0.760 (0.514), and the expression level of Tim-1 mRNA in Henoch-Schonlein purpura group and healthy control group were 0.760 (0.514) and 0.760 (0.514), respectively. There was no significant difference (P <0.05), and there was no difference between the simple group and the mixed group in the patients with Henoch-Schonlein purpura. The relative expression of Tim-3 mRNA was 1.359 (1.183) and 1.604 (1.177), respectively. There was no significant difference between the simple group and the mixed group in the patients with Henoch-Schonlein purpura (P> 0.05). There was no significant difference (P> 0.05). The levels of IL-2 in the allergic purpura group and the healthy control group were 188.517-12.867 and 202.759-20.903 (pg/ ml), respectively. .531-7.922 (pg/ ml), two The levels of IL-4 in the Henoch-Schonlein purpura group and the healthy control group were 73.046-8.750 and 62.301-11.232 (pg/ ml), respectively. 79.218鹵8.591(pg/ml) Conclusion: In this study, there was a significant difference between the two groups (P <0.05). Conclusion: The present study suggests that there is an immune function disorder in HSP, the subpopulation of Th2 cells is dominant, the expression of Tim1mRNA is increased, and Tim protein may be involved in the pathogenesis of HSP, but not related to the severity of the disease and the development of the disease, and the decrease of IL-2 and the increase of IL-4. the change in the hybrid group may be more pronounced, prompting i
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R725.5

【參考文獻】

相關期刊論文 前10條

1 師鎖柱,田月,陳香美;I型纖溶酶原激活物抑制物在紫癜腎炎腎組織中的表達[J];中國組織化學與細胞化學雜志;2001年02期

2 吳舒華 ,江華;過敏性紫癜患兒血清IFN-α、IL-2、IL-4的變化[J];華中醫(yī)學雜志;2002年02期

3 常紅,阿爽;過敏性紫癜急性期患兒淋巴細胞凋亡特征的研究[J];山東醫(yī)藥;2003年14期

4 潘繼豹,葉家鶴;過敏性紫癜體液免疫狀態(tài)分析[J];上海醫(yī)學檢驗雜志;2000年02期

5 董勝英,陳彤,張秋業(yè),董增義,雷珂;過敏性紫癜病兒急性期外周血輔助性T淋巴細胞亞群功能的變化[J];齊魯醫(yī)學雜志;2004年02期

6 潘凱麗;白慶峰;黃瑩;李琦;;過敏性紫癜患兒血清白細胞介素-4-、6-、8及腫瘤壞死因子-α表達的意義[J];實用兒科臨床雜志;2007年21期

7 解德瓊;甘華;杜曉剛;李正榮;巫江;;終末期腎病患者Th1/Th2型細胞因子的特征與外周血T細胞凋亡的關系[J];細胞與分子免疫學雜志;2006年06期

8 劉文彬,王太森,王劍峰,鄭淑梅,李琴;初發(fā)過敏性紫癜患兒免疫功能研究[J];西南國防醫(yī)藥;2004年02期

9 李秋,楊錫強,李永柏,王莉佳;過敏性紫癜T淋巴細胞功能狀態(tài)的研究[J];中華兒科雜志;2001年03期

10 高玉興，池永學，李亞榮，尹永杰，劉禹仁;過敏性紫癜白細胞介素2水平及其受體表達[J];中華兒科雜志;1995年02期

本文編號：2483083