| Research background Henoch-Sch?nlein purpura(HSP)is a systemic immune disease that can implicate systemic vasculitis.It is characterized by Ig A immune complex,complement deposition,inflammatory factors and leukocyte proliferation and infiltration on the walls of small vessels.The incidence of HSP in school-age children is high,which can involve multiple organs.It is easy to relapse and affects the child patients’ quality of life.The long-term prognosis depends on the degree of renal involvement,and some children’s condition protracts,even develops to final-stage kidney disease.The etiology and pathogenesis of HSP are gradually being recognized,but still are not fully elucidated.In recent years,there are more and more researches on the role of vitamin D in the pathogenesis of HSP,in which the correlation between serum vitamin D level and HSP has received more and more attention.Purpose By comparing the levels of vitamin D in child patients with different clinical types of HSP and healthy children in control group,as well as the correlation between vitamin D level and immunoglobulin and complement,to explore the correlation between vitamin D and the pathogenesis of HSP and its possible mechanism.Method The subjects of our hospital from September 2018 to April 2019 were selected.148 cases of child patients with HSP(case group)were selected according to the inclusion criteria,and 75 children who had physical examination in outpatient clinic(control group)were selected according to the inclusion criteria in the same period.According to the kidney involvement,the children with HSP were divided into 36 cases of Henoch Sch?nlein purpura nephritis(HSPN)and 112 cases of Non Henoch Sch?nlein purpura nephritis(NHSPN).The NHSPN group included simple rash type(n = 9),rash with abdominal pain type(n = 25),rash with joint type(n = 40)and mixed type(n = 38).The levels of 25(OH)D in serum were divided into three segments: appropriate > 20ng/ml,shortage 15-20 ng/ml and deficiency ≤15 ng/ml;t-test was used to compare the differences of 25(OH)D level between two groups.Using one-way ANOVA analysis,compare the difference of 25(OH)D level between healthy group,HSPN group and NHSPN group;The percentage of 25(OH)D level at its segment in each clinical classification was compared,and the correlation between 25(OH)D level in serum and immunoglobulin and complement in children with HSP was analyzed by Spelman test.Spelman test was used to analyze the correlation between serum immunoglobulin and complement levels and 25(OH)D levels in each HSP clinical classification.Result: The average level of 25(OH)D in serum of children with HSP was 18.40 ±6.67 ng/ml,and that of 25(OH)D in healthy control group was 24.08 ±10.69 ng/ml.There was significant difference between the two groups(t = 4.209,P < 0.001).There was a significant difference in the average level of 25(OH)D between the healthy group and the HSPN group and the NHSPN group(P <0.001),while there was no significant difference between the HSPN group and the NHSPN group(P = 0.472).There was no significant difference in 25(OH)D level among different clinical types(P > 0.5),but the average level in HSPN group was lower.In the serum 25(OH)D deficiency segment,the proportion of HSPN group was the highest.The 25(OH)D level was negatively correlated with the corresponding Ig A level in children with rash-joint type HSP(r =-0.381,P = 0.015),but not correlated with Ig G,Ig M,Ig E,C3 and C4.In children with HSP,25(OH)D was positively correlated with Ig G(r = 0.184,P = 0.025),but not correlated with Ig A,Ig M,Ig E,C3 and C4.Conclusion: There is a low level of 25(OH)D status in the serum of children with HSP,and there may be a lower status in children with renal involvement.25(OH)D may be involved in the pathogenesis of HSP by regulating humoral immune function. |
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