尿表皮生长因子和尿微量清蛋白及β_2微球蛋白与过敏性紫癜患儿早期肾损伤的相关性

Correlation Study between Urine Epidermal Growth Factor,Urine Microalbumin,β_2-Microglobulin and Early Renal Injury in Children with Henoch-Schonlein Purpura

目的探讨尿表皮生长因子(EGF)、尿微量清蛋白(MA)及β2-微球蛋白(β2-MG)与过敏性紫癜(HSP)及过敏性紫癜性肾炎(HSPN)发病的关系与相关性;探寻HSP早期肾损伤敏感的实验室指标。方法HSP患儿73例,分为HSP组(皮肤型组、混合型组、HSPN型组);健康对照组;治疗前组、治疗后组。采用酶联免疫吸附双抗体夹心法(ABC-ELISA)测定各组尿EGF,采用放射免疫分析法测定尿MA及β2-MG水平。结果1.HSPN型组尿EGF水平为(173.90±112.53)μg/L,高于皮肤型组(89.22±40.21)μg/L和混合型组(132.96±56.41)μg/L;HSPN型组尿MA水平为(46.34±18.49)mg/L,高于皮肤型组(12.30±6.73)mg/L和混合型组(24.31±12.66)mg/L;HSPN型组尿β2-MG水平为(0.52±0.39)mg/L,高于皮肤型组(0.26±0.18)mg/L及混合型组(0.35±0.25)mg/L,其差异均有统计学意义(Pa<0.05)。2.尿EGF水平治疗前组[(122.16±63.71)μg/L]高于治疗后组[(59.13±11.60)μg/L]及健康对照组[(24.74±8.75)μg/L];MA水平治疗前组[(43.09±10.46)mg/L]高于治疗后组[(12.94±5.73)mg/L]及健康对照组[(6.12±3.91)mg/L];尿β2-MG水平治疗前组[(0.45±0.25)mg/L]高于治疗后组[(0.29±0.16)mg/L]及健康对照组[(0.19±0.12)mg/L](Pa<0.05),且治疗后组与健康对照组比较差异有统计学意义(P<0.05)。3.HSP患儿肾损害中BUN/Cr阳性13例(阳性率17.81%),尿检阳性22例(阳性率30.14%),BUN/Cr加尿检阳性35例(阳性率47.95%),β2-MG阳性49例(阳性率67.12%),MA阳性53例(阳性率72.60%),EGF阳性67例(阳性率91.78%)。EGF、MA和β2-MG分别与BUN/Cr、尿检、BUN/Cr加尿检阳性率比较,差异均有统计学意义(Pa<0.05)。4.尿EGF与尿MA和β2-MG水平均呈正相关(r=0.444,0.426Pa<0.05)。结论EGF参与了HSPN的发病过程,尿EGF、MA及β2-MG可作为反映早期HSP患儿肾损伤的指标之一。

Objective To explore the correlation between urine epidermal growth factor （EGF） ,urine microalbumin（MA） and β2 - microglobnlin（ β2 -MG）and Henoch -Schonlein purpura （HSP）in children and explore sensitive laboratory indications of early renal damage for treatment of HSP. Methods Children involved in the experiments were divided into 3 groups, including HSP group ： HSP were divided into pure purpura group, mixed pattern group and HSP nephritis （HSPN） group ; normal control group ; pretreatment and post - treatment group. EGF was detected by using double - antibody sandwich ABC - ELISA, MA and β2 - MG detected by using radioimmunoassay. Results 1. HSP comparison of clinical classification found that the urine EGF [ （ 173.90 ± 112.53 ） μg/L vs （ 89.22 ± 40.21 ）μg/L, （ 132.96 ± 56.41） μg/L],MA[（46.34±18.49） mg/Lvs （12.30±6.73） mg/L,（24.31 ±12.66） mg/L] and β2-MG[（0.52±0.39） mg/L vs （0.26±0. 18） mg/L,（0.35±0.25） mg/L] level in HSPN group was higher than those in other groups（Pa 〈0.05）.2. The 3 indexes of post - treatment group were lower than pretreatment group and control group[ EGF： （ 122.16 ± 63.71 ） μg/L vs （59.13 ± 11.60） μg/L, （24.74±8.75） μg/L;MA：（43.09±10.46） mg/Lvs （12.94 ±5.73） mg/L,（6.12±3.91） mg/L;β2-MG：（0.45±0.25） mg/L vs （0.29 ±0. 16） mg/L, （0.19 ±0.12） mg/L] （Pa 〈0.05） ;post -treatment group were higher than control group（P 〈0.05） ,show statistical significance. 3. Comparison of abnormity ratio in early period of 73 HSP children, serum BUN/Cr 13 cases （17.81% ）, urine routine test 22 cases （30. 14% ） ,BUN/Cr plus urine routine test 35 cases（47.95% ） ,urine β2 - MG 49 cases（67. 12% ） ;MA 53 cases（72.60% ） ;EGF 67 cases （91.78%） ,EGF, MA, β2 -MG respectively compared with BUN/Cr, urine routine test, BUN/Cr plus urine routine test show statistical significance（Pa 〈0.05）.4. The correlation coefficients among EGF,MA and β2 - MG were respectively（r =0.444,0.426 Pa 〈0.05）. Conclusion EGF may involve in the development of HSP, urine EGF, MA and β2 - MG are sensitive markers of renal damage in early stage of HSP patients.