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目的探讨过敏性紫癜(HSP)患儿尿表皮生长因子(EGF)质量浓度检测及其对早期肾损害的诊断价值。方法91例HSP患儿为山东省青岛市妇女儿童医疗保健中心2003-01—2004-12住院确诊患儿,采用双抗体夹心ELISA方法检测HSP患儿和30例正常对照组儿童的尿EGF和尿视黄醇结合蛋白(RBP)质量浓度,同时采用全自动特殊蛋白分析仪测定尿微量白蛋白(MA)质量浓度。结果(1)HSP患儿尿EGF质量浓度[(78.59±18.09)ng/mL]明显高于正常对照组[(29.30±13.92)ng/mL],差异有显著性(t值为13.64,P<0.01)。HSP各临床分型间比较发现紫癜肾型尿EGF质量浓度[(98.31±17.68)ng/mL]分别高于其它临床型:皮肤型[(78.76±12.66)ng/mL]、腹型[(77.16±11.77)ng/mL]、关节型[(76.49±17.45)ng/mL]、混合型[(77.71±13.49)ng/mL],差异均有显著性意义(P均<0.05),而其余各临床分型间比较差异无显著性(P均>0.05)。(2)HSP患儿尿MA质量浓度为(43.21±10.23)mg/L,明显高于正常对照组[(6.41±2.86)mg/L],两者比较差异有显著性(t′=25.91,P<0.01)。(3)HSP患儿尿RBP质量浓度为(46.8±20.9)ng/mL,明显高于正常对照组[(12.8±4.8)ng/mL],差异有显著性(t′=11.98,P<0.01)。(4)91例急性期受检患儿中尿常规异常者14例(15.38%),尿MA升高者37例(61.67%),尿RBP升高者45例(75%),尿MA和(或)RBP升高者51例(85%),尿EGF升高者84例(92.3%),尿EGF阳性率与文献报道肾活检的相仿。结论HSP患儿尿EGF、RBP、MA质量浓度均明显增高,EGF在HSP伴有肾损害者早期升高尤为明显,考虑EGF增高可能与HSP病理改变程度有关,因此,EGF增高可作为HSP早期肾损害的敏感指标之一。

Value of early diagnosis about urine epidermal growth factor level in children with Henoch-Schonlein purpura nephritis

??AbstractObjectiveTo investigate the value of early diagnosis about urine epidermal growth factor( EGF) concentration change in children with Henoch??Schonlein purpura nephritis (HSPN).MethodsBi??antibody ELISA was adopted to detect the urine EGF and RBP levels in 91 HSP and 30 healthy children.The urine MA level was detected by automatic special protein analyzer.Results(1)The urine EGF concentration in HSP patients [(78.59??18.09)ng/mL] was significantly higher than that of control group[(29.30??13.92)ng/mL]??the difference being remarkable (t=13.64??P<0.01).Comparison in every kind found that the urine EGF concentration[(98.31??17.68)ng/mL]in purpura nephropathy was higher than that in any other kind:skin type[(78.76??12.66)ng/mL]?? abdominal type[(77.16??11.77)ng/mL]??joint type[(76.49??17.45)ng/mL]??mixed type[(77.71??13.49)ng/mL];there was clinical statistical significance(both P<0.05)??but there was no statistical significance in the latter four kinds(both P??0.05).(2) The concentration of urine MA in HSP group was[(43.21??10.23)mg /L],much higher than that in control group[(6.41??2.86)mg/L];there was notable difference in the two groups(t??=25.91??P<0.01).(3) The concentration urine RBP in HSP group was[(46.8??20.9)ng/mL]??much higher than that in control group[(12.8??4.8)ng/mL],so there was statistical significance(t??=11.98??P<0.01).(4) In the acute period of 91 HSP children,abnormality in urine routine test was 14(15.38%),higher urine MA level was in 37(61.67%)and higher RBP level was in 45(75%),higher in all the two indicator was in 51(85%)??higher urine EGF level was in 84(92.3%)??and the positive rate of urine EGF was similar to that in kidney puncture reported.ConclusionBoth the concentrations of urine EGF??RBP and MA are remarkably high in HSP children.The EGF level is especially high in early stage of HSPN.The increase of EGF level is possibly correlated with the degree of pathology change in HSP.So,the urine EGF level could be one of sensitive indictors in early kidney damage of HSP.