血清热休克蛋白70与妊娠的相关性研究

目的探讨妊娠期间母体与血清热休克蛋白之间的关系。方法用双抗体夹心ELISA法检测114例孕妇血清热休克蛋白含量,按孕3、5、7、8个月和足月共分五组,与非孕对照组比较。结果孕3-8个月组血清HSP70蛋白的含量与非孕对照组比较无差异（P〉0.05）,足月孕妇组血清HSP70含量明显升高,与非孕对照组比较有非常显著性差异（P〈0.001）;重度妊高征患者血清热休克蛋白70含量明显高于同孕龄正常孕妇组（P〈0.001）。结论了解不同孕月健康孕妇血清HSP70含量,可为妊娠期间某些疾病引起的血清HSP70升高,提供参考依据。     

过敏性紫癜患儿尿蛋白和内皮素的临床关联研究

研究过敏性紫癜（HSP）、过敏性紫癜性肾炎（HSPN）患儿尿清蛋白与内皮素1（ET-1）在HSP、HSPN发生发展中的作用。对对照组（21例）和紫癜患儿（29例）,用磺柳酸比浊法测定尿清蛋白排泄率（UAER）,用放射免疫法（RIA）测定血清ET-1水平,比较UAER和ET-1在HSP与HSPN的水平变化以及在HSPN治疗前后的水平变化。HSP组与对照组24h尿清蛋白比较无显著差异（P〉0.05）,HSPN组与对照组、HSP组比较有非常显著差异（P〈0.01,）;ET-1在HSP组与对照组比较有显著差异（P〈0.05）;HSPN组与对照组、HSP组比较有非常显著差异和显著差异（P〈0.01,P〈0.05）;HSPN组治疗后24h尿清蛋白和ET-1降低,较治疗前有非常显著差异（P〈0.01）;24h尿清蛋白与血清ET-1呈正相关关系（r=0.504,P〈0.05）。ET-1参与HSP、HSPN的发病,并与尿蛋白的发生、发展有关。     

急性心肌梗死猝死者心肌细胞hsf1和HSP70改变的意义

目的探讨急性心肌梗死猝死者梗死区心肌细胞内热休克转录因子1（hsfl）和热休克蛋白70（HSP70）改变的临床意义。方法分别用RT-PCR和免疫组化法检测（IHC）18例急性心肌梗死猝死者（研究组）和15例心脏正常因车祸快速死亡者（对照组）心肌细胞中hsfl和HSP70基因的mRNA和蛋白表达量。结果急性心肌梗死猝死者心肌细胞hsfl和HSP70的mRNA表达量都显著高于正常对照组（P〈0.01），且hsfl和HSP70mRNA的表达量之间呈显著的正相关关系（P〈0．001）。急性心肌梗死猝死者心肌细胞hsfl和HSP70蛋白在细胞浆和细胞核表达较对照组显著增强（P〈0.001），其中hsfl蛋白主要在心肌细胞核内表达，HSP70蛋白主要在心肌细胞浆内表达。结论急性心肌梗死猝死者心肌细胞内hsfl和HSPT0可能共同参与了急性心肌梗死的病理生理过程．这一过程可能是热休克反应的另一调节途径。     

外周血单个核细胞在不同介质中HSP70形成的研究

目的研究外周血单个核细胞（PBMC）在不同介质中热休克蛋白（Heat shock protein HSP）70的表达。方法抽取16例健康志愿者外周血，应用密度梯度法分离单个核细胞，在不同介质中42℃热休克0．5、1h，免疫组化染色测定热休克蛋70的形成。结果PBMC在不同介质中热休克蛋白70形成与空白相比有明显差异（P〈0．01）；在1640培养液和血清中热休克0.5h，热休克蛋白70的表达差异明显（P〈0．01）；在1640培养液中热休克0．5h和1h间无显著差别（P〉0．05）。结论热休克蛋白的形成与介质密切相关，只有当变性蛋白质达到一定的量才能启动热休克蛋白基因的转录、合成。     

AGT、ACE基因多态性与成人过敏性紫癜和过敏性紫癜性肾炎的相关性

目的探讨肾素-血管紧张素系统中AGT基因M235T和ACE基因I／D多态性与过敏性紫癜和过敏性紫癜性肾炎易感性的关系。方法应用PCR和PCR—RFLP技术检测145例过敏性紫癜／过敏性紫癜性肾炎患者与172例正常对照组血管紧张素原基因第2外显子M235T多态性及血管紧张素转换酶基因第16内含子I／D多态性。结果①AGT基因型构成比在HSP组、HSPN组与正常对照组之间差异有统计学意义（P=0．008,P=0．002）,但在HSP和HSPN之间差异无统计学意义（P=0．180）。AGT—TT基因型和丁等位基因携带者具有较高的患HSP、HSPN的风险。②ACE基因型构成比在HSPN组与正常对照组之间差异有统计学意义（P=0．003）,但在HSP和正常对照组、HSP和HSPN之间差异无统计学意义（P=0．065,P=0．073）。ACE—DD基因型和D等位基因携带者具有较高的患HSPN的风险。结论携带AGT基因M235T多态性增加患HSP／HSPN的风险,携带ACE基因I／D多态性增加患HSPN的风险。     

白三烯受体拮抗剂治疗反复发作的儿童过敏性紫癜的临床探讨

目的观察白三烯受体拮抗剂孟鲁司特治疗反复发作的儿童过敏性紫癜（HSP）的临床疗效。方法选择2008年2月-2011年2月我院收治的48例反复发作的儿童过敏性紫癜（1ISP）患儿随机分为两组，对照组（23例）采用常规治疗，治疗组（25例）在常规治疗基础上加服白三烯受体拮抗剂孟鲁司特（2—6岁为4mg／d、6—13岁为5mg／d，睡前服，共1个月）。结果治疗组总有效率（92％）明显高于对照组（60．8％），两组相比，P〈0．05。差异有统计学意义。结论白三烯受体拮抗剂盂鲁司特治疗反复发作的儿童过敏性紫癜（HSP）疗效较好。     

过敏性紫癜患儿血清IL-2、IL-6、IL-12急性期和恢复期的水平测定

目的通过过敏性紫癜（HSP）患儿的血清IL-2、IL-6、IL-12探讨过敏性紫癜（HSP）的免疫作用机制。方法采用双抗夹心酶联免疫吸附试验（ELISA）法对48例HSP患儿组和48例正常组比较。结果HSP患儿急性期的血清IL-6明显高于正常组（t=3．68P〈0．01）,血清IL-2、IL-12则显著下降（分别为t=4．976P〈0．01,t=3．175 P〈0．01）两组比较,差异有统计学意义。而HSP患儿恢复期的血清IL-2、IL-6、IL-12与正常组无明显差别（t=分别为0．703,0．374,0．490 P〉0．05）两组比较,差异无统计学意义。结论HSP患儿血清白细胞介素水平出现异常,机体存在免疫功能紊乱。     

HSP患儿血清IL-6、TNF-α和CRP水平的变化

目的：探讨血清白介素-6（IL-6）、肿瘤坏死因子（TNF-α）及C-反应蛋白（CRP）在过敏性紫癜（HSP）患儿中的表达及其临床意义。方法：29名单纯HSP患儿、23名紫癜性肾炎（HSPN）的患儿在治疗前及症状消失后3d,分别测定了血清IL-6、TNF-α（用ELISA）和CRP（用免疫荧光法）的水平,并以50名正常健康儿童作为对照组。结果：所有52名HSP患儿的血清IL-6、TNF-α和CRP水平在治疗前均较对照组显著升高,在治疗后,虽有显著下降（P〈0.01）,但仍显著高于对照组。伴有肾炎的患儿其血清TNF-α水平显著高于单纯HSP的患儿组,IL-6和CRP的水平两组并无显著差异。HSP患儿的血清TNF-α水平与IL-6、CRP存在中等程度正相关关系（r=0.668,P〈0.01;r=0.601,P〈0.01）;HSP患儿的血清IL-6水平与CRP存在着显著正相关关系（r=0.851,P〈0.01）。结论：HSP/HSPN的发病过程存在细胞因子和CRP的参与,TNF-α在HSPN发生中的作用机制,尚待进一步探讨。     

来氟米特对紫癜性肾炎患者血清IL-6、IL-8及TNF-α水平的影响

目的：探讨来氟米特对过敏性紫癜性肾炎患者血清白细胞介素6（IL-6）、白细胞介素8（IL-8）及肿瘤坏死因子α（TNF-α）水平的影响及其临床意义。方法：应用双抗体夹心ELISA法对23例过敏性紫癜性肾炎患者治疗前后血清IL-6、IL-8和TNF-α水平进行检测，23例健康成人作为正常对照组。结果：过敏性紫癜性肾炎患者血清IL-6、IL-8和TNF-α水平明显高于正常对照组，来氟米特治疗后患者IL-6、IL-8和TNF-α水平明显降低（P〈0．05）。结论：IL-6、IL-8和TNF-α参与过敏性紫癜性肾炎的发生发展，来氟米特治疗过敏性紫癜性肾炎可能与调节炎性细胞因子的产生，抑制炎症反应有关。     

免疫球蛋白A1和肝细胞生长因子与腹型过敏性紫癜患儿胃组织损伤关系的研究

目的探讨IgAl和肝细胞生长因子（HGF）在腹型过敏性紫癜（I-1SP）患儿胃肠道损伤中的作用。方法取临床有持续或反复腹痛的腹型HSP患儿胃黏膜组织的病例为腹型HSP组,取胃镜检查明确诊断为急性胃炎患儿胃黏膜组织的病例为非HSP胃炎组;取胃肿瘤患儿切除部分胃的远离肿瘤部分、并经病理证实为正常胃黏膜组织的病例为正常对照组。运用免疫组织化学非生物素二步法检测IgA、IgAl和HGF蛋白在各组胃黏膜组织中的表达情况。结果腹型HSP组20例,非HSP胃炎10例,正常对照组4例。①腹型HSP组胃黏膜组织IgA、IgAl蛋白主要表达于胃黏膜上皮的表面黏液细胞内和固有层管状腺间的间质细胞、炎症细胞内;其免疫分数显著高于非HSP胃炎组和正常对照组,IgA蛋白：（0．61±0．02）vs（0．55±0．04）和（0．14±0．03）,IgAl蛋白：（0．58±0．05）vs（0．38±0．03）和（0．13±0．05）;腹型HSP组IgAl／IgA免疫分数比值（0．94±0．02）亦显著高于非HSP胃炎组（0．69±0．06）;②腹型HSP组胃黏膜组织中HGF蛋白主要表达于胃黏膜固有层的管状腺细胞内,其免疫分数显著高于非HSP胃炎组和正常对照组,（0．16±0．03）vs（0．39±0．08）和（0．50±0．01）,差异有统计学意义;③腹型HSP组胃黏膜组织中IgAl与HGF蛋白的表达水平呈正相关（r=0．892,P〈0．01）。结论对于无典型皮疹的腹型HSP患儿,IgA!及HGF可能作为病理学指标对HSP诊断及鉴别提供新的依据。     

38例过敏性紫癜患儿的临床病例分析

目的:分析过敏性紫癜(HSP)患儿的临床资料,总结该病的临床特征。方法:对38例HSP患儿流行病学及临床表现特征进行回顾性分析。结果:发病年龄在7~14岁者占73.68%,四季均有发病,10~12月份发病率占全年发病的68.42%。发病诱因中感染占68.42%,接触过敏原占13.16%。100%的患儿有皮肤紫癜,有关节症状,消化道症状和肾脏损害者分别占31.58%,47.36%和10.53%。结论:过敏性紫癜好发于秋冬季节,感染、过敏为其主要发病诱因,主要受累器官为皮肤、关节、胃肠道、肾脏,可单独或同时存在。     

初发过敏性紫癜患儿肾脏受累危险因素分析

目的对初发过敏性紫癜（HSP）患儿进行随访,探讨HSP患儿肾脏受累的危险因素。方法前瞻性纳入2009年12月至2010年11月在南京医科大学附属南京儿童医院肾脏科住院的初发HSP患儿,随访6个月,根据肾脏受累定义,将HSP患儿分为肾脏受累组和无肾脏受累组。复习文献提取与肾脏受累可能相关的3项人口学特征、8项临床症状和17项辅助检查指标进行分析,先行单因素分析,对有统计学意义的变量行Logistic回归分析。结果研究期间共纳入初发HSP患儿283例,平均发病年龄为（7.2±2.6）岁（8月龄至16岁）。239/283例（84.5%）完成随访。283例初发HSP患儿均有紫癜样皮疹表现,分别有194/283例（68.6%）和224/283例（79.2%）患儿有消化道和关节症状。80/239例（33.5%）患儿在随访过程中出现肾脏受累,以孤立性蛋白尿为主（44/80例,55.0%）。发病1个月内出现肾脏受累者占50.0%（40/80例）,3个月内出现肾脏受累者占88.8%（71/80例）。单因素分析提示年龄≥8岁、皮疹反复、皮疹持续≥2周、无菌性白细胞尿、血清白蛋白、血小板平均容积（MPV）≥10fL、胱抑素C（CysC）≥0.8mg·L^-1和血清C3≤0.88g.L-1在肾脏受累组和无肾脏受累组间差异有统计学意义（均P〈0.05）。多因素Logistic回归分析结果显示,无菌性白细胞尿：OR=4.178,95%CI：2.061～8.468,皮疹持续≥2周：OR=2.474,95%CI：1.367～4.478,MPV≥10fL：OR=2.948,95%CI：1.533～5.667,CysC≥0.8mg·L^-1：OR=2.101,95%CI：1.067～4.134。结论无菌性白细胞尿、皮疹持续≥2周、MPV≥10fL和CysC≥0.8mg·L^-1为初发HSP患儿肾脏受累的独立危险因素。     

糖皮质激素预防过敏性紫癜患儿肾损害随机对照试验的Meta分析

目的 评价糖皮质激素对过敏性紫癜（HSP）患儿肾损害的预防作用.方法 检索Cochrane图书馆、Medline、EMBASE、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库等,收集有关糖皮质激素预防HSP患儿肾损害的RCT或类随机对照试验（quasi-RCT）文献,检索文献起止时间均为1990年1月至2012年6月.由2名作者进行资料提取和文献质量评价.应用RevMan 4.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析.结果 5篇RCT和1篇quasi-RCT进入Meta分析.4篇文献描述了具体随机化方法,采用了充分的分配隐藏和盲法,纳入6篇文献均报道了失访和退出情况;4篇为低度偏倚风险,2篇为高度偏倚风险.Meta分析结果显示,诊断HSP后6个月以内肾损害的发生率,糖皮质激素预防组为22.2%（42/189）,对照组为26.3%（50/190）,合并RR=0.67（95%CI：0.17～2.62）,差异无统计学意义,P=0.57;诊断HSP后6个月以上肾损害发生率,糖皮质激素预防组为10.9%（41/373）,对照组为12.6%（46/364）,合并RR=0.85（95%CI：0.44～1.64）,差异无统计学意义,P=0.65.剔除2篇高度偏倚风险文献行敏感性分析,结果无改变.结论 本Meta分析结果尚不支持早期糖皮质激素治疗能预防HSP患儿肾脏损害.建议临床医生根据患儿具体临床表现和实验室检查,慎重应用糖皮质激素或辅以抗凝、抗过敏等对症治疗.     

The level of IgA antibodies to human umbilical vein endothelial cells can be enhanced by TNF-alpha treatment in children with Henoch-Schönlein purpura

Anti‐endothelial cell antibodies (AECA) have been found to play an important role in many vascular disorders. In order to determine the presence of AECA in children with Henoch–Schönlein purpura (HSP), and to elucidate the pathogenic and clinical value of their measurement in this disease, AECA were detected by immunofluorescence staining and a human umbilical vein endothelial cell (HUVEC)‐based enzyme‐linked immunosorbent assay (ELISA) in 20 children with HSP, 10 children with juvenile rheumatoid arthritis (JRA) without vasculitis and 10 normal healthy children. Antibodies against another endothelial cells, human dermal microvascular endothelial cells (HMVEC‐d) were also detected by cell‐based ELISA. In some experiments, we compared the binding activity of antibodies to HUVEC with and without tumour necrosis factor‐α (TNF‐α) or interleukin‐1 (IL‐1) pretreatment. Patients with acute onset of HSP had higher serum levels of IgA antibodies, both against HUVEC and against HMVEC‐d, than healthy controls (P = 0·001, P = 0·008, respectively). Forty‐five per cent of patients had positive IgA AECA to HUVEC, and 35% had positive IgA AECA to HMVEC‐d. The titres of IgA antibodies to HUVEC paralleled the disease activity. After TNF‐α treatment, the values of IgA AECA to HUVEC in HSP patients were significantly increased (P = 0·02). For IgG and IgM AECA, there was no difference between HSP patients and controls (P = 0·51, P = 0·91). Ten JRA children without vasculitis had no detectable IgG, IgM or IgA AECA activity. The results of this study showed that children with HSP had IgA AECA, which were enhanced by TNF‐α treatment. Although the role of these antibodies is not clear, IgA AECA provide another immunological clue for the understanding of HSP.     

Elevated levels of anti-Helicobacter pylori antibodies in Henoch-Schönlein purpura

OBJECTIVE: Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by IgA-containing deposits in the skin, joints, gastrointestinal mucosa and glomeruli. HSP is much rarer in adults than in children. Among a number of other pathogenic factors, Helicobacter pylori (Hp) has recently been implicated in the gastrointestinal and extra-gastrointestinal manifestations underlying HSP. We aimed at studying the occurrence of Hp infections in 11 adult HSP patients with appearance in our clinical practice in the last 5 years. METHODS: Eleven adult HSP and 20 healthy adult patients were recruited for this study. Anti-Hp IgG and IgA antibodies were assessed in sera of HSP patients with active (n = 5) and remittent disease (n = 6) and healthy controls (n = 20) in the context of clinical symptoms, endoscopic evaluation, as well as routine and immunolaboratory observations. Concurrent Hp infection was confirmed by urease test and histology. RESULTS: Anti-Hp antibodies were present in 10/11 of HSP patients, and 11/20 of healthy controls. However, only 4/11 HSP patients had concurrent Hp infection as confirmed by urease test and/or histology. In the healthy controls the actual Hp infection was detectable in 9/20 cases. Patients in the acute phase had significantly higher levels of anti-Hp IgG compared to healthy controls (86.0 +/- 32.0 versus 25.5 +/- 28.5 U/ml, p < 0.05). In contrast, anti-Hp IgA/IgG ratios were significantly higher in the remitting phase compared to the control group (3.1 +/- 1.8 versus 0.8 +/- 0.5 ratio, p < 0.05). Among other immunolaboratory markers, serum CRP, circulating IgA and serum tumor necrosis factor-alpha levels were significantly increased in acute patients compared to healthy group results (45.3 +/- 22.7 versus 4.8 +/- 3.5 mg/l, p < 0,05); (58.9 +/- 18.2 versus 25.2 +/- 6.4pg/ml, p < 0,05); (5.5 +/- 1.1 versus 2.4 +/- 1.2 g/l; respectively, p < 0.05). CONCLUSIONS: Hp infection may be associated with the development and progression of HSP. IgG antibodies to Hp may be present mostly in acute HSP, while IgA antibodies may be involved in sustaining gastrointestinal symptoms underlying the chronic phase of the disease.     

低危SBI发热新生儿快速筛查指标的初步研究

目的探索一种简单、有效的对新生儿非严重细菌感染（serious bacterial infection,SBI）性发热性疾病的早期鉴别方法,为减少抗生素使用提供有效依据。方法选取2006年1月到2007年6月入住我科的发热新生儿为研究对象。病人情况完全符合预先确定的指标体系者视为SBI低危组,其他则归为SBI高危组,比较两组SBI发病率和两组病例入院后发热持续时间并推断该指标体系对SBI的阴性预测值（negative predictive value,NPV）。结果在153例发热新生儿中,SBI低危组共58例,仅2（3.45%）例最终被确诊为SBI;相对于SBI高危组95例中有51（53.68%）例确诊为SBI,其差异有统计学意义（P〈0.001）。该指标体系对SBI的阴性预测值为96.55%（其95%可信区间为91.86%-100%）。结论该指标体系可简单、快速、可靠排除发热新生儿为SBI,具有一定临床指导意义。     

Modified Sipjeondaebo-tang (JAROTANG) for Henoch-Schonlein purpura nephritis (HSPN): Two case reports

IntroductionHenoch–Schönlein purpura (HSP) is a disease commonly manifesting purpura, joint pain, and gastrointestinal symptoms. It can lead to glomerulonephritis (Henoch–Schönlein purpura nephritis, HSPN), which is directly associated with mortality and progression to chronic kidney disease (CKD). While HSP occurs more commonly in children, deadly outcomes occur at a higher rate in adult patients. Previous studies have not reported effective treatment of HSPN by Western or traditional medicine. Here, we report two cases of adult HSPN patients treated with the herbal medicine Jarotang (JRT, modified Sipjeondaebo-tang, modified SJDBT).Case summaryTwo female patients (Cases 1 and 2), who were 26 and 27 years old, respectively, came to visit us complaining mainly of cutaneous purpura. Both women were diagnosed with HSP, and the results of urinalysis indicated that the HSP had already progressed to renal involvement (3+ proteinuria with 3+ urine occult blood in case 1; 100–120 RBC/HPF with 2+ urine occult blood in Case 2). Both patients were given modified SJDBT in the name of JRT, with some herbs added to disperse and circulate stagnant qi, relieve indigestion, and clear heat. After treatment, patient 1 showed only a trace level of urine occult blood, with disappearance of purpura and proteinuria. Patient 2 showed complete remission of purpura and hematuria.ConclusionsModified SJDBT, namely, JRT was effective in treating 2 cases of adulthood HSP and subsequent nephritis. This may be due to the ability of this therapy to replenish qi and blood and/or its immunological effect on T cells. The medication can serve as an effective cure for HSPN.     

Thrombopoietin and interleukin-6 levels in Henoch-Sch?nlein purpura.

BACKGROUND AND PURPOSE: Depending on the severity of the illness, thrombocytosis is found in about 60% to 70% of patients with Henoch-Sch?nlein purpura (HSP). Whether thrombocytosis is the result of an inflammatory reaction mediated by thrombopoietin (TPO) or other inflammatory cytokines such as interleukin (IL)-6 remains unknown. METHODS: Thirty two patients who met the diagnostic criteria for HSP were included. They were divided into two groups - HSP patients with thrombocytosis (n = 14) and those without thrombocytosis (n = 18) with a platelet count of 400,000/microL. Eight normal healthy controls were also included. TPO and IL-6 serum levels during the acute phase were measured by enzyme-linked immunosorbent assay. RESULTS: Patients with platelet counts greater than 400,000/microL in the acute stage had significantly lower TPO levels than patients with platelet counts lower than 400,000/microL (310 +/- 65.6 pg/mL vs 608 +/- 97.8 pg/mL, p=0.013). However, HSP patients with or without thrombocytosis had similar TPO levels as the healthy controls (441 +/- 176 pg/mL, p=0.89 and 0.29, respectively). IL-6 serum levels were significantly elevated in HSP patients during the acute stage of HSP (28.6 +/- 61.7 pg/mL vs 3.16 +/- 1.35 pg/mL, p=0.049). In patients with complications of glomerulonephritis or gastrointestinal hemorrhage (n = 12), IL-6 levels were significantly lower than in those without such complications (8.07 +/- 3.79 pg/mL vs 40.9 +/- 16.9 pg/mL, p=0.007). CONCLUSIONS: This study showed that thrombocytosis in HSP patients is a type of inflammatory reactive thrombocytosis, and that IL-6 may also play a role in the pathogenesis of HSP.     

儿童腹型过敏性紫癜的超声表现

目的探讨腹型过敏性紫癜（HSP）的超声表现及诊断价值。方法选择2009年6月至2009年12月83例腹型HSP患儿,其中男性49例,女性34例;年龄2～16岁,平均年龄7.72岁。回顾性分析临床诊断腹型HSP患儿的超声表现。结果病变肠管以小肠为主,肠壁肿胀,内部可分层,血流信号增多,呈乏蠕动状态。可出现盆腔积液或淋巴结增大,肠系膜回声改变等伴发表现。结论儿童腹型HSP的超声表现有一定特异性,可对受累肠管进行细致观察及时随诊,有助于早期提示该病,并可以用于观察其并发症及临床疗效。超声检查可作为儿童腹型HSP的常规首选检查。