Changes Of Immunity Status In Children With Henoch Schonlein Purpura Nephritis Before And After Application Of Glucocorticoid Or Combined With Immunosuppressants:A Restrospectively Compared Trial

Objective:retrospectively analyze the changes of immune functions in children with Henoch-Schonlein purpura nephritis treated with glucocorticoid or glucocorticoid combined with tacrolimus or mycophenolate mofetil according to clinical classification,so as to provide futher evidence for clinical treatment.Methods:117 children with purpura nephritis hospitalized in the Pediatrics of the First Affiliated Hospital of Kunming Medical University from January 2015 to January 2021 as the research object,These 117 children were all in accordance with the diagnosis of purpuric nephritis.According to the type of drugs,they were divided into 3 groups:GC group、TAC group、MMF group.The three groups were selected to complete the whole laboratory examination of immunoglobulin and complement and lymphoid subset before and after the treatment.Results:1.Before treatment,IgA、Total IgE are obviously higher than the reference when IgG、IgM、C3、C4 are lower in every group;All the three drugs had inhibitory effects on IgA,IgG,IgM and total IgE,The comparison on IgA,IgG between groups after one month of treatment are statistically significant(p<0.016).At the end of observation,GC combined with MMF had the strongest inhibitory effect on C4 when GC combined with TAC is strongest in other item.2.Before treatment,the absolute value of lymphocyte,the ratio of T lymphocyte and B lymphocyte among the three groups were significantly higher than the reference when the ratio of NK cell was mostly higher,the ratio of CD4+was significantly lower than the reference value when the ratio of CD8+was mostly lower;After the beginning of treatment,the comparison between each two groups was statistically significant(p<0.016).At the end of,GC combined with MMF had the strongest inhibitory effect on absolute value of lymphocytes,T lymphocytes,CD8+T cells and NK cells when GC combined with TAC had the strongest inhibitory effect on CD4+T cells and B lymphocytes.Conclusions:1.Humoral immunity and/or cellular immunity also can present in HSPN children with immune disorder,and cellular immunity is the main one.2.The disorder of cellular immunity is mainly manifested as the decrease of CD4+,the increase of CD8+,the imbalance of CD4+/CD8+,and B lymphocyte activation.3.GC,TAC and MMF also have strong immunosuppressive effect.In humoral immunity,the inhibitory effect of TAC was stronger than that of MMF;In cellular immunity,TAC had stronger inhibitory effect on CD4+and B lymphocytes than MMF,while MMF had stronger inhibitory effect on CD8+and NK cells than TAC.4.The inhibition of TAC and MMF on CD4+was mainly at the first month after treatment,while humoral immunity,CD8+,NK cells and B cells were half of year after treatment.