过敏性紫癜患儿尿液脂氧素A_4、NF-κB的变化及其临床意义

Urinary lipoxin A_4 and NF-κB levels in children with Henoch-Sch?nlein purpura and their clinical significance

目的探讨脂氧素A4(LXA_4)、NF-κB在过敏性紫癜(HSP)患儿尿液中的变化及在HSP发病机制中的作用。方法选取50例HSP患儿为病例组,其中紫癜性肾炎(HSPN)患儿20例;同期25例腹股沟疝术前患儿为对照组。留取晨尿,采用ELISA法检测尿液LXA_4、NF-κB水平,比较病例组急性期、恢复早期与对照组LXA_4、NF-κB水平,并比较HSPN患儿与非HSPN患儿急性期LXA_4、NF-κB水平,分析病例组急性期LXA_4和NF-κB的相关性。同时收集各组临床资料及病例组24h尿蛋白定量等实验室检查结果,分析HSPN患儿急性期LXA_4、NF-κB水平与24h尿蛋白定量的相关性。结果病例组急性期、恢复早期尿液LXA_4水平均显著高于对照组(均P<0.01),且急性期显著低于恢复早期(P<0.01);病例组急性期、恢复早期尿液NF-κB水平亦均显著高于对照组(均P<0.05),且急性期显著高于恢复早期(P<0.01)。HSPN患儿急性期尿液LXA_4水平显著低于非HSPN患儿,NF-κB水平显著高于非HSPN患儿,差异均有统计学意义(均P<0.05)。病例组急性期尿液LXA_4水平与NF-κB水平呈负相关(r=0.347,P<0.05)。HSPN患儿急性期24h尿蛋白定量与LXA_4水平呈负相关(r=0.562,P<0.05),与NF-κB无相关性(r=0.370,P>0.05)。结论NF-κB可能参与HSP发病,并与病情严重程度相关,而LXA_4可能为肾脏保护因子,且可能通过抑制NF-κB发挥抗炎作用。

Objective To investigate the changes of lipoxin A4（LXA4） and nuclear factor-κB（NF-κB） levels in the urine of children with Henoch-Sch？nlein purpura（HSP）, and their clinical significance. Methods Fifty children with HSP, including 20 with HSP nephritis（HSPN）, and 25 age-matched children with inguinal hernia（control group） were enrolled in the study. The morning urine specimens were collected and ELISA was used to determine the levels of LXA4 and NF-κB. LXA4 and NF-κB levels were compared between case and control groups, and among different subgroups, and the correlation between LXA4 and NF-κB was analyzed. Results The urinary LXA4 levels in acute phase and early recovery phase of HSP patients were significantly higher than those in control group（both P〈0.01）, and the urinary LXA4 levels in acute phase patients were significantly lower than those in early recovery phase（P 0.01）. The urinary NF-κB levels in acute phase and early recovery phase of HSP patients were also significantly higher than those in control group（both P〈0.05）, while the urinary levels of NF-κB in acute phase was significantly higher than those in early recovery phase（P〈0.01）. The urinary levels of LXA4 in acute phase of HSP patients without kidney damage were significantly higher than those in HSPN, and the urinary levels of NF-κB were significantly lower（P〈0.05）. There was a significantly negative correlation between the urinary levels of LXA4 and NF-κB（r=0.347, P〈0.05） in acute phase HSP patients. Meanwhile, there was a significantly negative correlation between LXA4 and 24-h urinary protein（r=0.562, P〈0.05）,while there was no correlation between NF-κB and 24-h urinary protein（r=0.370, P 〉0.05） in acute phase of HSPN. Conclusion NF-κB may be involved in the pathogenesis of HSP, and associated with disease severity. LXA4 may protect kidney against inflammation by inhibiting NF-κB.