儿童紫癜性肾炎血清、尿液VCAM-1水平及临床意义

Concentration of VCAM-1 in Serum and Urine in Henoch-Schonlein Purpura Nephritis and its Clinical Significance

目的:探讨紫癜性肾炎(HSPN)患儿的血清、尿液可溶性血管细胞黏附分子-1(sVCAM-1)水平变化及临床意义。方法:过敏性紫癜(HSP)患儿50例,按有无肾脏累及分为HSPN组(30例)和HSP无肾受累(NO-HSPN)组(20例);正常对照组20例。应用ELISA法检测各组血清、尿液sVCAM-1水平,进行比较,并分析其与主要临床指标(包括24 h尿蛋白、尿红细胞)的关系。结果:HSPN组和NO-HSPN组的血清sVCAM-1水平[分别为(809.79±173.32)ng/ml、(623.44±67.27)ng/ml]均高于对照组(494.79±59.84)ng/ml,P<0.01,HSPN组的血清sVCAM-1水平高于NO-HSPN组(P<0.01)。HSPN组的尿液sVCAM-1水平(121.24±110.83)ng/ml高于对照组(20.61±16.76)ng/ml和NO-HSPN组(19.37±12.93)ng/ml,P均<0.01,NO-HSPN组的尿液sVCAM-1水平与对照组比较,无统计学差异(P>0.05)。HSPN患儿中,蛋白尿组高于无蛋白尿组(P均<0.01),肾病蛋白尿组高于蛋白尿组(P均<0.05)和无蛋白尿组(P均<0.01);肉眼血尿组的血清sVCAM-1水平高于无血尿组,与镜下血尿组比较无统计学差异(P>0.05);镜下血尿组的血清sVCAM-1浓度高于无血尿组(P<0.01);镜下血尿组和肉眼血尿组的尿液sVCAM-1水平明显高于无血尿组(P均<0.05),镜下血尿组和肉眼血尿组之间无统计学差异(P>0.05)。HSPN患儿的血清和尿液sVCAM-1水平均与24 h尿蛋白量和尿红细胞量呈显著性正相关(P均<0.01)。结论:VCAM-1可能参与了HSPN的发生、发展过程;尿液sVCAM-1的检测在监测肾脏损害方面具有较好的临床实用价值。

Objective：To explore the concentration of ,soluble vascular cellular adhesion molecule- 1 （sVCAM- 1 ） in serum and urine in children with Henoch- Schonlein purpura nephritis（HSPN） and explore its clinical significance. Methods：There were 50 patients with HSP in the study. They were divided into two groups according to their renal lesions：30 cases with HSPN and 20 cases without HSPN（as NO-HSPN group）. The control group included 20 healthy children. The concentration of sVCAM- 1 in serum and urine of all children were detected by enzymelinked immunosorbent assay（ ELISA）. Then we compared the concentrations in every group and analyzed the relationship between the concentrations of sVCAM - 1 and the main clinical markers （including 24 hours urinary protein and urinary erythrocyte）. Results： The serum concentrations of sVCAM- 1 in HSPN group （809.79 ±173.32） ng/ml and NO- HSPN group （623.44 ±67.27）ng/ml were both significantly higher than those in the control group （ 494.79 ±59.84）ng/ml （P〈 0.01 ）. The serum concentration of sVCAM- 1 in HSPN group was significantly higher than that in NO- HSPN group （P〈0.01）. The urinary concentration of sVCAM- 1 in HSPN group were significantly higher than those in NO- HSPN group （P〈 0.01 ） and the control group （P〈 0.01）, but there was no significant difference between the NO- HSPN group and the control group （P 〉 0.05）. The concentration of VCAM - 1 in the proteinuria group was significantly higher than that in the no-proteinuria group （P〈 0.01 ）. The concentration of VCAM- 1 in the nephropathy proteinuria group was significantly higher than those in the proteinuria group （P 〈 0.05） and the no - proteinuria group（P 〈 0.01 ）. The serum concentration of sVCAM - 1 in the gross hematuria group was significantly higher than that in the no- hernaturia group （P〈 0.01 ）, but was not significantly different from that in the microscopic hematuria group （P 〉 0.05）. The serum concentration of sVCAM- 1 in the microscopic hema- turia group was higher than that in the no- hematuria group （P 〈 0.01 ） too. The urinary concentrations of sVCAM- 1 were different in the groups with different levels of hematuria, because sVCAM- 1 levels were significantly higher in the grass hematuria group and the microscopic hematuria group than that in the no-hematuria group （P 〈 0.05）. But it was not significantly different between the microscopic hematuria group and the gross hematuria group （P 〉 0.05）. There was a significantly positive correlation between the concentration of sVCAM - 1 both in serum and in urine and the level of 24 hours urinary protein and urinary erythrocyte too （P 〈 0.01）. Conclusion： It suggest that VCAM- 1 is involved in the course of the onset and the development of HSPN. The sVCAM- 1 in urine is worthy of detection for monitoring the renal lesions.