Application value of Th17/Treg immune imbalance in the diagnosis and disease evaluation of children with abdominal Henoch-Schonlein purpura

doi:10.3877/cma.j.issn.2095-2015.2025.02.012

Abstract

Abstract:

Objective

To explore the application value of Th17/Treg immune imbalance in the diagnosis and disease evaluation of children with abdominal Henoch-Schonlein purpura （HSP）.

Methods

A total of 122 children with abdominal HSP admitted to Taihe County People's Hospital from January 2019 to March 2024 were retrospectively analyzed，and 95 children with acute gastroenteritis （AG） and 109 healthy children were selected for comparison. Baseline clinical data and peripheral blood samples were collected from all subjects. Flow cytometry was used to detect the levels of Th17 and Treg in peripheral blood of children with abdominal HSP，and the Th17/Treg ratio was calculated. The ROC curve was drawn to analyze the diagnostic and differential efficacy of Th17/Treg ratio for abdominal HSP. According to the symptom score，the children with abdominal HSP were further divided into mild，moderate and severe groups，and the Th17/Treg ratio in peripheral blood of children with abdominal HSP with different disease severity was compared. Pearson coefficient was used to analyze the correlation between Th17/Treg ratio and IgA level. Logistic regression model was used to analyze the risk factors of severe abdominal HSP.

Results

Compared with AG group and healthy children group，the children with abdominal HSP group had significantly higher Th17 level and Th17/Treg ratio，and a significantly lower Treg level （all P＜0.05）.In healthy children and children with abdominal HSP，the AUC of Th17/Treg in the diagnosis of abdominal HSP was 0.898 （sensitivity 93.44%，specificity 81.65%）. The AUC of Th17/Treg in differentiating AG from HSP was 0.822 （sensitivity was 81.97%，specificity was 71.58%）. With the aggravation of the severity of abdominal HSP，the level of Th17 and Th17/Treg ratio in peripheral blood gradually increased，while the level of Treg gradually decreased （all P＜0.05）. The Th17/Treg ratio in peripheral blood of children with abdominal HSP was positively correlated with IgA level （r=0.407，P＜0.05）. Increased CRP，D-dimer，serum IgA and Th17/Treg ratio were independent risk factors for severe abdominal HSP （all P＜0.05）.

Conclusion

Th17/Treg immune imbalance has a significant value in the diagnosis and disease evaluation of abdominal HSP in children.

Key words: Abdominal Henoch-Schonlein purpura, Th17/Treg, Immune imbalance, Children, Early diagnosis

Wenhai Bao, Qin Ruan, Feifei Li. Application value of Th17/Treg immune imbalance in the diagnosis and disease evaluation of children with abdominal Henoch-Schonlein purpura[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(02): 162-167.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2025.02.012

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2025/V15/I02/162

Figures/Tables 6

项目	健康儿童组（n=109）	AG 组（n=95）	HSP 组（n=122）	F/H/χ ²	P
年龄（岁）	10（5，14）	10（6，15）	10（5，14）	1.864	0.394
男/女（例）	67/42	52/43	73/49	1.021	0.600
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	19.69±2.00	19.57±1.84	19.85±2.04	0.561	0.571
皮肤紫癜持续时间［例（%）］
≤28 d			106（86.89）
＞28 d			16（13.11）
实验室指标（ $\overset{ˉ}{x}$ ± s ）
TT（s）	11.73±2.82	11.57±2.85	9.59±2.14^*#	24.125	＜0.001
PT（s）	12.06±1.82	11.90±1.38	8.59±1.34^*#	189.164	＜0.001
FIB（g/L）	2.24±0.56	2.20±0.59	4.79±0.85^*#	530.689	＜0.001
PLT（×10⁹/L）	140.07±29.17	142.15±27.17	224.28±29.93^*#	316.946	＜0.001
WBC（×10⁹/L）	6.60±1.58	8.04±1.67^*	10.12±1.96^*#	117.528	＜0.001
CRP（mg/L）	6.78±1.83	8.08±1.98^*	11.13±2.97^*#	103.877	＜0.001
D-D（mg/L）	0.45±0.11	0.61±0.14^*	2.81±0.75^*#	908.978	＜0.001
IgA（g/L）	1.23±0.33	1.31±0.28	2.09±0.44^*#	199.348	＜0.001
IgM（g/L）	1.28±0.28	1.38±0.32	1.37±0.42	2.358	0.096
IgG（g/L）	9.10±2.17	9.35±2.09	9.56±2.32	1.288	0.277

项目	健康儿童组（n=109）	AG 组（n=95）	HSP 组（n=122）	F/H/χ ²	P
年龄（岁）	10（5，14）	10（6，15）	10（5，14）	1.864	0.394
男/女（例）	67/42	52/43	73/49	1.021	0.600
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	19.69±2.00	19.57±1.84	19.85±2.04	0.561	0.571
皮肤紫癜持续时间［例（%）］
≤28 d			106（86.89）
＞28 d			16（13.11）
实验室指标（ $\overset{ˉ}{x}$ ± s ）
TT（s）	11.73±2.82	11.57±2.85	9.59±2.14^*#	24.125	＜0.001
PT（s）	12.06±1.82	11.90±1.38	8.59±1.34^*#	189.164	＜0.001
FIB（g/L）	2.24±0.56	2.20±0.59	4.79±0.85^*#	530.689	＜0.001
PLT（×10⁹/L）	140.07±29.17	142.15±27.17	224.28±29.93^*#	316.946	＜0.001
WBC（×10⁹/L）	6.60±1.58	8.04±1.67^*	10.12±1.96^*#	117.528	＜0.001
CRP（mg/L）	6.78±1.83	8.08±1.98^*	11.13±2.97^*#	103.877	＜0.001
D-D（mg/L）	0.45±0.11	0.61±0.14^*	2.81±0.75^*#	908.978	＜0.001
IgA（g/L）	1.23±0.33	1.31±0.28	2.09±0.44^*#	199.348	＜0.001
IgM（g/L）	1.28±0.28	1.38±0.32	1.37±0.42	2.358	0.096
IgG（g/L）	9.10±2.17	9.35±2.09	9.56±2.32	1.288	0.277

组别	例数	Th17（%）	Treg（%）	Th17/Treg（%）
健康儿童组	109	0.91±0.21	2.84±0.58	34.62±14.56
AG 组	95	1.01±0.23^*	2.34±0.32^*	43.79±11.68^*
腹型HSP 组	122	1.15±0.16^*#	2.04±0.45^*#	58.23±11.29^*#
F		103.616	40.930	86.653
P		＜0.001	＜0.001	＜0.001

组别	例数	Th17（%）	Treg（%）	Th17/Treg（%）
轻度组	37	1.08±0.11	2.36±0.56	47.38±7.56
中度组	46	1.12±0.17	1.98±0.31^*	57.17±6.43^*
重度组	39	1.24±0.14^*#	1.80±0.25^*	69.77±7.07^*#
F		98.154	12.686	21.261
P		＜0.001	＜0.001	＜0.001

项目	单因素Logistic 分析			多因素Logistic 分析
项目	P 值	HR 值	95% CI	P 值	HR 值	95% CI
年龄	0.349	0.899	0.721～1.123
性别	0.793	1.110	0.509～2.421
BMI	0.442	0.928	0.768～1.122
皮肤紫癜持续时间	0.008	4.425	1.475～13.275	0.327	4.798	0.208～110.633
TT	0.644	0.959	0.801～1.147
PT	0.442	0.893	0.669～1.192
FIB	0.438	0.835	0.530～1.316
PLT	0.566	0.996	0.984～1.009
WBC	0.038	1.245	1.012～1.531	0.364	0.731	0.372～1.438
CRP	＜0.001	4.739	2.526～8.890	0.028	2.749	1.117～6.765
D-D	＜0.001	36.006	9.239～140.315	0.029	5.991	1.198～29.969
IgA	＜0.001	22.381	5.761～86.953	0.046	12.051	1.048～138.577
IgM	0.449	0.701	0.279～1.758
IgG	0.401	0.931	0.788～1.100
Th17/Treg	＜0.001	1.574	1.303～1.901	0.009	1.269	1.061～1.518

References 29

［1］	Yang X，Lu R，Liu Q，et al. Analysis of the influencing factors of abdominal Henoch-Schonlein purpura in children with gastrointestinal bleeding and the clinical value of PLR［J］. Am J Transl Res，2024，16（8）： 3867-3874.
［2］	Castañeda S，Quiroga-Colina P，Floranes P，et al. IgA Vasculitis（Henoch-Schönlein Purpura）： An Update on Treatment［J］. J Clin Med，2024，13（21）： 6621.
［3］	Jia L，Wu J，Wei J，et al. Proteomic analysis of urine reveals biomarkers for the diagnosis and phenotyping of abdominal-type Henoch-Schonlein purpura［J］. Transl Pediatr，2021，10（3）： 510-524.
［4］	Teng X，Gao C，Sun M，et al. Clinical significance of fecal calprotectin for the early diagnosis of abdominal type of Henoch-Schonlein purpura in children［J］. Clin Rheumatol，2018，37（6）： 1667-1673.
［5］	Du L，Wang P，Liu C，et al. Multisystemic manifestations of IgA vasculitis［J］. Clin Rheumatol，2021，40（1）： 43-52.
［6］	陈思迁，吴捷. 儿童腹型过敏性紫癜研究进展［J］. 国际儿科学杂志，2016，43（1）： 48-50，55.
［7］	于小璇，杨莉，王康民. 马栗树籽提取物通过 miR-155-5p/Th17/Treg 轴对过敏性紫癜大鼠炎性反应抑制及肾保护作用的研究［J］. 中国中西医结合皮肤性病学杂志，2023，22（6）： 501-507.
［8］	周丽娟，单馨慧，胥卫青，等. 白芍总苷对过敏性紫癜小鼠Treg/Th17 免疫平衡及JAK1/STAT3 信号通路蛋白的影响［J］. 中国免疫学杂志，2023，39（8）： 1660-1664.
［9］	李根，马翠. 过敏性紫癜患儿外周血微小RNA-155、Toll 样受体2、Toll 样受体4、氧化应激指标表达水平与Th17/Treg 平衡的关系［J］. 陕西医学杂志，2023，52（3）： 301-304.
［10］	胡亚美，江载芳. 诸福棠实用儿科学［M］. 北京：人民卫生出版社，2002： 1204-1205.
［11］	Jiang M，Dai J，Jiang C，et al. Long noncoding RNA MEG8 induces an imbalance of Th17/Treg cells through the miR-107/STAT3 axis in Henoch-Schonlein purpura rats［J］. Aging（Albany NY），2023，15（23）：13854-13864.
［12］	中华医学会儿科学分会免疫学组，《中华儿科杂志》编辑委员会.儿童过敏性紫癜循证诊治建议［J］. 中华儿科杂志，2013，51（7）： 6.
［13］	Leung AKC，Barankin B，Leong KF. Henoch-Schönlein Purpura in Children： An Updated Review［J］. Curr Pediatr Rev，2020，16（4）：265-276.
［14］	Hammad H，Krausz J，Barcan M，et al. Adult Henoch-Schönlein Purpura： Comprehensive Assessment of Demographic，Clinical，and Histopathological Features as Predictors for Systemic Involvement［J］. Dermatology，2023，239（4）： 609-615.
［15］	Di Pietro GM，Castellazzi ML，Mastrangelo A，et al. Henoch-Schönlein Purpura in children： not only kidney but also lung［J］.Pediatr Rheumatol Online J，2019，17（1）： 75.
［16］	Gautam S，Kumar R，Kumar U，et al. Yoga maintains Th17/Treg cell homeostasis and reduces the rate of T cell aging in rheumatoid arthritis： a randomized controlled trial［J］. Sci Rep，2023，13（1）：14924.
［17］	Zavvar M，Assadiasl S，Zargaran S，et al. Adoptive Treg cell-based immunotherapy： Frontier therapeutic aspects in rheumatoid arthritis［J］.Immunotherapy，2020，12（12）： 933-946.
［18］	Lee YK，Mukasa R，Hatton RD，et al. Developmental plasticity of Th17 and Treg cells［J］. Curr Opin Immunol，2009，21（3）： 274-280.
［19］	Chen O，Zhu XB，Ren H，et al. The imbalance of Th17/Treg in Chinese children with Henoch-Schonlein purpura［J］. Int Immunopharmacol，2013，16（1）： 67-71.
［20］	Li B，Ren Q，Ling J，et al. The change of Th17/Treg cells and IL-10/IL-17 in Chinese children with Henoch-Schonlein purpura： A PRISMA-compliant meta-analysis［J］. Medicine（Baltimore），2019，98（3）： e13991.
［21］	Li YY，Li CR，Wang GB，et al. Investigation of the change in CD4⁺ T cell subset in children with Henoch-Schonlein purpura［J］. Rheumatol Int，2012，32（12）： 3785-3792.
［22］	Jen HY，Chuang YH，Lin SC，et al. Increased serum interleukin-17 and peripheral Th17 cells in children with acute Henoch-Schönlein purpura［J］. Pediatr Allergy Immunol，2011，22（8）： 862-868.
［23］	Xue X，Liu Q，Xu W，et al. Imbalanced Th17/Treg in peripheral blood of adult patients with immunoglobulin A vasculitis nephritis［J］.Cent Eur J Immunol，2021，46（2）： 191-198.
［24］	Wang Y，Zhang S，Zhang N，et al. Reduced activated regulatory T cells and imbalance of Th17/activated Treg cells marks renal involvement in ANCA-associated vasculitis［J］. Mol Immunol，2020，118（5）： 19-29.
［25］	Mekala DJ，Alli RS，Geiger TL. IL-10-dependent infectious tolerance after the treatment of experimental allergic encephalomyelitis with redirected CD4+CD25+ T lymphocytes［J］. Proc Natl Acad Sci U S A，2005，102（33）： 11817-11822.
［26］	Bettelli E，Oukka M，Kuchroo VK. T（H）-17 cells in the circle of immunity and autoimmunity［J］. Nat Immunol，2007，8（4）： 345-350.
［27］	高鸿博，王艳飞，隗晓华，等. D-D、FIB、IL-18、IGF-1 与儿童过敏性紫癜患者预后的相关分析［J］. 河北医药，2023，45（6）： 829-832.
［28］	罗卓夫，何渊民，许飏. Lp-PLA2、NLR 及CRP 对成人过敏性紫癜复发的预测价值［J］. 标记免疫分析与临床，2020，27（6）： 1001-1005.
［29］	刘钧菲. 紫癜性肾炎患儿纤维蛋白原、D-D 水平与肾损害关系的研究［J］. 锦州医科大学学报，2019，40（6）： 47-49.

[1]	Hongyu Tao, Jingjing Ye, Jin Yu, Xiuzhen Yang, Jingjing Qian, Bin Xu, Weize Xu, Qiang Shu. Value of contrast transthoracic echocardiography in assessing right-to-left shunt-related diseases in children [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 959-965.
[2]	Haoran Tang, Biao Zhou, Te Ba, Yangyang Li. Research progress of biomarkers related to early diagnosis of sepsis after severe burn [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2025, 20(01): 70-74.
[3]	Meilan Wang, Yingqin Gao, Yang Xiao, Zhengcai Li, Ting Zhang, Yan Liang, Yanqi Liang, Kaizheng Liu, Lei Guo. Detection of positive rate of eosinophil cationic protein-myeloperoxidase and antiviral combination therapy for children with respiratory virus infection and allergic rhinitis [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(06): 327-334.
[4]	Qing Huang, Junjie Lei, Jialong Pan, Dongyun Lin. Coinfection of Streptococcus pneumoniae and Epstein-Barr virus in pediatric necrotizing pneumonia: a case report and literatures review [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(06): 377-383.
[5]	Linjuan Zhao, Jie Lv, Wensheng Wang, Demao Ma, Tao Hou. Study on the effect of ultrasound guided resection of stellate and cylindrical lactation preserving areas with staining marks [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 634-637.
[6]	Zhixin Liu, Xiaolin Cheng, Wenjun Xiao, Siqi Liu. Application of day surgery mode in laparoscopy for hydrocele in children [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 36-40.
[7]	Miao Sun, Shengde Wu. Robot-assisted technology for treating pediatric hydronephrosis：a scope review [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 95-102.
[8]	Hebei Ding, Xun Wang, Weiguo Chen. Comparison of application of sevoflurane inhalation anesthesia and propofol intravenous anesthesia in pediatric indirect inguinal hernia surgery [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 570-574.
[9]	Kuilin Lyu, Hong Chen. Analysis of epidemiological and clinical characteristics of 465 pediatric cases of Mycoplasma pneumoniae pneumonia： a single-center retrospective study [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(01): 55-61.
[10]	Yuhan Yuan, Shengli Yang. Research progress in proteomic analysis of body fluids and tissues in early molecular diagnosis of liver cancer [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 883-888.
[11]	Chinese Society of Organ Transplantation of Chinese Medical Association, Surgery Group of Chinese Society of Surgery of Chinese Medical Association, Transplantation Group of Chinese Society of Surgery of Chinese Medical Association, South China Alliance of Split Liver Transplantation. Chinese Clinical Practice Guidelines on Split Liver Transplantation in Children [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 593-601.
[12]	Caiyun Han, Jiao Ma, Yan Li. Study on the correlation between serum PAF and sTM levels and rotavirus enteritis and dehydration degree in children [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(01): 83-88.
[13]	Chen Zhang, Ming Qin, Juan Dong, Yulong Chen. Diagnostic value of ultrasound in ischemic changes of intestinal volvulus in children [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 565-568.
[14]	Yun Wang, Lei Liu, Min Xu, De Huai. Clinical efficacy and safety of dupilumab injection combined with Yupingfeng granules in treatment of moderate to severe atopic dermatitis in children [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(01): 27-32.
[15]	Rongchang Wu, Xiaolian Fang, Lei Yang, Chengyue Zhang, Junyang Zhao, Yun Peng, Jia You, Jie Yin. Complications of intra-arterial chemotherapy for retinoblastomas：a single-center study analysis [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(01): 49-53.

Please choose a citation manager

Content to export