不同病理类型HSPN患儿血和尿中VEGF浓度改变

目的：探讨过敏性紫癜性肾炎（Henoch Schonlein purpura nephritis，HSPN）患儿尿中血管内皮生长因子（vascular endothelial growth factor，VEGF）浓度与肾脏血管损害的关系。方法：对肾穿刺活检确诊的78例HSPN患儿按肾血管损害、肾小球病理损害、肾小管间质病理损害进行半定量积分，肾小球、肾小管间质、血管病理积分及肾小球与肾小管间质总病理积分各分为轻、中、重3组；酶联免疫吸附法检测其血、尿中VEGF浓度；免疫组织化学法检测肾局部VEGF表达及肾脏微血管密度。结果：肾小球、肾小管间质、血管病理积分及肾小球与肾小管间质总病理积分轻、中、重组之间差异有统计学意义（均P＜0.01）；肾脏血管损害愈轻，微血管密度、血与肾局部中VEGF浓度则愈高，而尿中VEGF排泄也愈低，轻、中、重组3组之间差异有统计学意义（均P＜0.01）。肾小球积分与肾小管间质积分、血管积分、肾脏总积分相互呈高度正相关（r=0.596，0.612,0.728,分别P<0.05，0.05，0.01），微血管密度与血VEGF和肾VEGF相互呈高度正相关，与尿中VEGF呈高度负相关（r=0.601,0.696,-0.639，均P＜0.01）。结论：尿中VEGF排泄增加使肾局部VEGF浓度下降进而导致的肾血管损伤,可能是HSPN患儿肾血管损害与病理慢性进展的重要原因。

Serum and urine VEGF concentration of different pathological types in children with Henoch Schonlein purpura nephritis

Objective To explore the relationship between vascular endothelial growth factor (VEGF) concentration in urine and renal vascular damage in children with Henoch Schonlein purpura nephritis (HSPN).Methods The kidney pathological lesion of 78 biopsy-proven HSPN children was assessed with renal vascular damage, glomerular pathological damage, and tubulointerstitial pathological damage semi-quantitative points. The children were divided into 3 groups (light, medium, and heavy group) according to the renal vascular, glomerular, tubulointerstitial, glomerular and tubulointerstitial total pathological points. Blood and urine vascular endothelial growth factor concentration was detected by enzyme linked immunosorbent assay;the localized renal VEGF expression and microvessel density were detected by immunohistochemistry assay in the kidneys. Results The semi-quantitative points of glomerular, tubulointerstitial, renal vascular, and glomerular and tubulointerstitial total points in different groups had significant difference (all P＜0.01);the minor renal vascular damage, the higher light microvessel density, blood and kidney concentration of VEGF, and the VEGF excretion in the urine were also lower in different groups, and there were significant differences (all P＜0.01). Glomerular points were positively related with tubular points, vascular points, kidney total score (r=0.596,0.612, and 0.728;P＜0.05, 0.05, and 0.01 respectively). Microvessel density was highly positively related with blood VEGF and renal VEGF, and negatively rela-ted with urine VEGF (r=0.601, 0.696, and -0.639,all P＜0.01). Conclusion The urinary excretion of VEGF leads to the decrease of local kidney VEGF concentration resulting in the renal vascular injury, which may be the important reason for renal vascular damage and pathology chronic progress in HSPN children.