过敏性紫癜表现及治疗效果与淋巴细胞凋亡的关系

目的通过观察79例过敏性紫癜(HSP)患儿治疗前后淋巴细胞凋亡情况,进一步阐明淋巴细胞凋亡(LA)在HSP中的表现及与各种治疗效果的关系。方法采用原位末端标记技术,对过敏性紫癜患儿治疗过程中淋巴细胞凋亡分组进行测定,在光学显微镜下观察,计算出凋亡比率,然后将急性期与正常组比较、病情较轻的HSP皮肤型与病情较重的HSP复合型比较、恢复期与正常组比较、常规方法治疗未愈的治疗前后比较、常规方法治疗及加用免疫抑制剂方法的治疗前后比较,各组均采用SPSS统计软件进行t检验统计学处理。结果发现急性期患儿组较正常对照组淋巴细胞凋亡情况有显著延迟(P<0.01),恢复期患儿组较急性期患儿组淋巴细胞凋亡情况有明显改善(P<0.01),恢复期患儿组与正常对照组淋巴细胞凋亡情况无明显的差异(P>0.05),经常规方法痊愈的HSP皮肤型淋巴细胞凋亡延迟情况已得到改善(P<0.01),但急性期未痊愈的HSP复合型淋巴细胞凋亡延迟情况未得到改善(P>0.05),急性期病情较重的HSP复合型较病情较轻的HSP皮肤型淋巴细胞凋亡延迟明显(P<0.05),应用雷公藤、激素、甲氨喋呤等免疫抑制剂后淋巴细胞凋亡加速(P<0.01)。结论急性期过敏性紫癜存在淋巴细胞凋亡的延迟,且症状较重HSP较症状较轻HSP的淋巴细胞凋亡延迟明显;经治疗达临床痊愈的恢复期过敏性紫癜淋巴细胞凋亡情况已达正常水平;常规方法治疗可使症状较轻的HSP淋巴细胞凋亡延迟得以改善,但对症状较重的复合型HSP的病例,须加用免疫抑制剂如雷公藤、激素、甲氨喋呤等使淋巴细胞凋亡加速,从而达到治愈目的。

The relationship between manifestation of Henoch-Schonlein purpura, its therapeutic effect and lymphocyte apoptosis

Objective To observe the lymphocyte apoptosis before and after the treatment in 79 children with Henoch-Schonlein Purpura(HSP) in order to understand the change of lymphocyte apoptosis(LA) and its relation with the the therapeutic effects of different regimens.Methods In situ end labeling technique was applied to determine the lymphocyte apoptosis during the treatment in children with HSP.After the observation under microscope,the ratio of apoptosis was calculated.Then comparisons were done between acute-stage and normal group,slight HSP skin-type and serious HSP complex-type group,recovery-stage and normal group, before and after treatment in incurred children by routine therapy,before and after the treatment by routine therapy plus immunosuppressive agents.All the groups were statistically treated by t test with SPSS. Results The lymphocyte apoptosis was obviously delayed in acute-stage group as compared with normal group(P<0.01).The lymphocyte apoptosis was significantly improved in recovery-stage group as compared with acute-stage group(P<0.01).There was no significant differences on lymphocyte apoptosis between recovery-stage group and normal group(P>0.05).In slight HSP skin-type patients who were cured by routine therapy,the delay of lymphocyte apoptosis has been improved(P<0.01).In serious HSP complex-type patients at acute stage who were not cured by routine therapy,the delay of lymphocyte apoptosis has not been improved(P>0.05).The lymphocyte apoptosis in serious acute-stage HSP complex-type was obviously delayed as compared with slight HSP skin-type(P<0.05).The lymphocyte apoptosis was accelerated after the application of tripterygium wilfordii,hormones,methotrexate or other immunosuppressive agents(P<0.01).Conclusion The delay of lymphocyte apoptosis did exist during acute stage in HSP,The delay of lymphocyte apoptosis was more obvious in serious HSP complex-type than that in slight skin-type.The lymphocyte apoptosis has returned to normal level in HSP chindren during the recovery stage after being clinically cured by treatment.The routine therapy could improve the delay of the lymphocyte apoptosis in slight HSP children.But in the children with serious HSP complex-type,immunosuppressive agents such as tripterygium wilfordii,hormones,methotrexate should be added to accelerate the lymphocyte apoptosis,by which the children could be clinically cured.