The Balance Of Regulation Of Th17/Treg In The Children With Henoch-schonlein Purpura Nephritis Using Huaiqihuang

Objectives:To observe the levels of Th17and associated cytokine IL-17and Treg in the peripheral blood with the children of Henoch-Schonlein purpura nephritis (HSPN), and explore the balance of regulation of Th17/Treg in HSPN.Methods:The objection were divided into three groups firstly: healthy children group (n=11), Henoch-Schonlein purpura (HSP) group (n=10) and Henoch-Schonlein purpura nephritis (HSPN) group (n=20). Healthy children were measured the level of IL-17by ELISA and the circulating frequencies of Th17and CD4+CD25+Treg cells by FCM. HSP group and HSPN group were measured IL-17、Th17cells and Treg cells when illness with acute attack and had not used any drugs. The pathological grading Ⅱas HSPNⅡ group (n=10) and then divided them into conventional therapy group (n=5) and Huaiqihuang group (n=5) by randomly. The pathological grading Ⅲa as HSPN Ⅲ group (n=10) and then divided them into prednisone group (n=5) and prednisone+Huaiqi huang group (n=5) by randomly. Conventional therapy group was treated with oral fosinopril5-10mg (5mg under the age of12, lOmg above the age of12) once daily and dipyridamole5mg/(kg.d) three times daily. Huaiqihuang group was treated with conventional therapy and oral Huaiqihuang keli lOg twice daily. Prednisone group was treated with conventional therapy and oral prednisone lmg/(kg.d) once daily. Prednisone+Huaiqihuang group was treated with conventional therapy、 prednisone and Huaiqihuang keli. After two moth treatments, we measured the level of IL-17and the circulating frequencies of Thl7and CD4+CD25+Treg cells.Results: The circulating frequencies of Thl7cells(1.77±0.81%、2.24±0.60%) and associated cytokine IL-17(50.36±18.81pg/ml、63.64±26.4pg/ml)in HSP and HSPN group were higher than healthy children group (Thl7:0.79±0.56%, IL-17:13.92±16.03pg/ml)(P<0.05), the circulating frequencies of Treg cells(4.26±3.52%、2.81±2.25%) were lower than healthy children group (10.21±4.80%)(P<0.05), but there was no significant difference between the HSP、HSPN Ⅱ and HSPN Ⅲ group. Thl7cells、IL-17levels and urinary sediment RBCs in conventional therapy group after treatment were lower than before(after:1.78±0.48%、40.22±8.63pg/ml、11.23±3.50×l04/ml;before:2.21±0.60%、62.66±34.19pg/ml、23.00±14.73×l04/ml),when Treg cells were higher than before (after:3.45±0.48%; before:2.94±1.95%), but there was no significant difference (P>0.05).24-hour urine proteins were lower after treatment than before (after:14.75±4.09mg/kg; before:27.52±9.65mg/kg)(P<0.05). Thl7cells、IL-17levels、24-hour urine proteins and urinary sediment RBCs in Huaiqihuang group after treatment were lower compared to before (after:0.89±0.34%、26.16±8.89pg/ml、8.70±1.48mg/kg、 5.23±1.13×104/ml; before:2.09±0.63%、61.28±26.37pg/ml、29.32±11.22mg/kg、19.66±4.72×104/ml) and conventional therapy group(P<0.05); But Treg cells were higher than before (after:8.49±1.35%; before:2.53±1.71%) and conventional therapy group (P<0.05). Th17cells、IL-17levels、24-hour urine proteins and urinary sediment RBCs in prednisone group after treatment were lower than before (after:1.15±0.56%、18.54±10.35pg/ml、5.28±2.08mg/kg,2.25±1.52×104/ml; before:2.29±0.61%、66.70±21.09pg/ml、29.00±7.55mg/kg、17.66±6.80×104/ml)(P<0.05); When Treg cells were higher than before (after:9.29±4.98%; before:3.12±2.8%)(P<0.05). Th17cells、IL-17levels、24-hour urine proteins and urinary sediment RBCs in Prednisone+Huaiqihuang group after treatment were lower compared to before (after:0.83±0.47%、13.46±7.42pg/ml、4.00±1.39mg/kg、2.56±1.98×104/ml; before:2.37±0.72%、65.94±28.86pg/ml、19.55±11.15mg/kg、19.50±8.84×104/ml)(P<0.05), when Treg cells were higher than before (after:13.71±4.04%; before:2.66±3.01%)(P<0.05). However, there was no statistically significant between prednisone group and Prednisone+Huaiqihuang group with Th17and Treg cells、IL-17levels、24-hour urine proteins and urinary sediment RBCs (P>0.05).Conclusion: Th17cells and associated cytokine IL-17levels increase in the peripheral blood with the children of Henoch-Schonlein purpura nephritis, While Treg cells decrease in Henoch-Schonlein purpura nephritis. Huaiqihuang could decrease Th17cells and IL-17level and increase Treg cells. Furthermore it could decrease hematuria and proteinuria.