血栓调节蛋白、血管性假血友病因子、基质金属蛋白酶-9在过敏性紫癜肾损害早期诊断中的价值

目的 探讨过敏性紫癜(HSP)患儿血浆血栓调节蛋白(TM)、血管性假血友病因子(vWF)、基质金属蛋白酶-9(MMP-9)在HSP肾损害早期诊断中的价值.方法 应用ELISA法检测60例健康儿童(健康对照组)及160例HSP患儿急性期血浆TM、vWF、MMP-9水平.随访6个月～1a,发生肾损害62例,非肾损害98例,按肾损害临床表现分为A组:孤立性血尿(18例)或孤立性蛋白尿(3例)；B组:血尿+蛋白尿(29例)；C组:大量蛋白尿(12例).比较肾损害组、非肾损害组及健康对照组中各数值变化及在肾损害不同组中的差异.结果 1.肾损害组TM( 148.13±18.60) mg·L-1]、vWF( 159.50±23.06)％]、MMP-9( 36.53±7.86)mg·L-1]均高于非肾损害组(129.49±21.22) mg·L-1、(136.98±25.48)％、(29.14±8.17) mg·L-1]及健康对照组(113.63±20.88) mg·L-1、(121.83±24.69)％、(24.37±7.34) mg·L-1],差异均有统计学意义(Pa＜0.05)；非肾损害组与健康对照组比较差异均无统计学意义(Pa＞0.05).2.肾损害组:C组、B组TM( 158.59±17.80) mg·L-1、(149.72±19.20) mg·L-1]、vWF(169.45±23.36)％、(160.20±21.46)％]、MMP-9 (42.66±6.31) mg· L-1、(35.88±7.33) mg·L-1]高于A组(131.28±16.14) mg·L-1、(139.59±19.26)％、(30.16±6.89) mg· L-1],差异均有统计学意义(Pa＜0.05)；C组MMP-9水平高于B组,差异有统计学意义(P＜0.05),而TM、vWF在2组之间差异均无统计学意义(Pa＞0.05).结论 TM、vWF、MMP-9在HSP急性期升高,可作为早期预测肾损害的指标,联合检测有利于早期预测肾损害的发生及肾损害的程度.

Clinical Value of Thrombomodulin, Von Willebrand Factor, Matrix Metalloproteinase- 9 in Earlier Diagnosis of Henoch - Schonlein Purpura Nephritis in Children

Objective To explore the value of thrombomodulin(TM),von Willebrand factor(vWF),and matrix metalloproteinase-9(MMP-9) in the early diagnosis of Henoch-Schonlein purpura(HSP)nephritis by detecting the plasma levels of the 3 factors in children with HSP. Methods The plasma levels of TM,vWF,MMP-9 were measured by enzyme-linked immunosorbent assay(ELISA) in 160 children with acute HSP and 60 healthy children(healthy control group),and they were followed up for 6 months to 1 year.In HSP group,62 cases of HSP nephropathy and 98 cases of HSP non-nephropathy patients were enrolled in the study.The patients with HSP nephropathy were divided into 3 subgroups according to different clinical features:subgroup A included single blood urine(n=18) or albuminuria(n=3),subgroup B included blood urine and albuminuria(n=29),and subgroup C included albuminuria(n=12).The levels of the 3 indexes in HSP nephropathy group,HSP non-nephropathy group and healthy control group were compared,respectively.Furthermore,the differences of 3 indexes in subgroup A,B and C of HSP nephropathy group were analyzed. Results 1.The plasma levels of TM(148.13±18.60) mg·L-1],vWF(159.50±23.06)%],MMP-9(36.53±7.86) mg·L-1] were significantly higher in HSP nephropathy group than those in the non-HSP nephropathy group(129.49±21.22) mg·L-1,(136.98±25.48)%,(29.14±8.17) mg·L-1] and those in control group(113.63±20.88) mg·L-1,(121.83±24.69)%,(24.37±7.34) mg·L-1],respectively(Pa<0.05).There was no significant difference in plasma levels of them between non-HSP nephropathy group and healthy control group(Pa>0.05).2.In HSP nephropathy group,the plasma levels of TM,vWF,MMP-9 in subgroup C and subgroup BTM:(158.59±17.80) mg·L-1,(149.72±19.20) mg·L-1;vWF:(169.45±23.36)%,(160.20±21.46)%;MMP-9:(42.66±6.31) mg·L-1,(35.88±7.33) mg·L-1] were significantly higher than those in subgroup A(131.28±16.14) mg·L-1、(139.59±19.26)%、(30.16±6.89) mg·L-1](Pa<0.05).In HSP nephropathy group,the plasma level of MMP-9 in subgroup C was significantly higher than that in subgroup B(P<0.05),whereas the plasma levels of TM,vWF had no significant difference between the 2 subgroups(Pa>0.05). Conclusions The increment of TM,vWF and MMP-9 in the acute phase of HSP can be used as an index for early prediction of kidney injury.Joint detection of TM,vWF and MMP-9 is useful to predict the occurrence and degree of HSP nephropathy early.