过敏性紫癜患儿的尿液LXA_(4)、TNF-α水平及其临床意义

Urinary LXA_(4) and TNF-a in children with henoch-schonlein purpura and their clinical significance

目的 探讨过敏性紫癜(HSP)患儿的尿液脂氧素A4(LXA_(4))、肿瘤坏死因子-α(TNF-α)水平及其临床意义。方法 选取71例HSP患儿作为HSP组,按是否存在肾脏损害分为肾损害组(35例)与无肾损害组(36例);同期选取30例健康体检儿童作为对照组。HSP组给予综合治疗。比较对照组与HSP组患儿的尿液LXA_(4)、TNF-α水平,肾损害组与无肾损害组患儿的尿液LXA_(4)、TNF-α水平;统计HSP组患儿的疗效;比较HSP组不同疗效患儿的尿液LXA_(4)、TNF-α水平,HSP组治疗有效患儿恢复早期和急性期的尿液LXA_(4)、TNF-α水平,肾损害组治疗有效患儿急性期和恢复早期的尿液LXA_(4)、TNF-α、β_(2)微球蛋白(β_(2)-MG)以及尿微量白蛋白(MA)水平。结果 HSP组尿液LXA_(4)、TNF-α分别为(494.35±102.65)pg/ml、(2.41±0.63)μg/L,均高于对照组的(262.15±100.51)pg/ml、(0.19±0.08)μg/L,差异有统计学意义(P<0.05)。无肾损害组患儿的尿液LXA_(4)(538.19±94.28)pg/ml高于肾损害组的(449.26±98.84)pg/ml,TNF-α(1.85±0.57)μg/L低于肾损害组的(2.99±0.48)μg/L,差异有统计学意义(P<0.05)。HSP组患儿治疗后有效66例(92.96%),无效5例(7.04%)。HSP组治疗有效患儿的尿液LXA_(4)(548.26±100.74)pg/ml高于治疗无效患儿的(328.16±58.19)pg/ml,TNF-α(1.01±0.11)μg/L低于治疗无效患儿的(1.79±0.38)μg/L,差异均有统计学意义(P<0.05)。HSP组治疗有效患儿急性期尿液LXA_(4)(498.28±104.29)pg/ml低于恢复早期的(975.29±108.62)pg/ml,TNF-α(1.77±0.21)μg/L高于恢复早期的(1.05±0.18)μg/L,差异有统计学意义(P<0.05)。肾损害组治疗有效患儿31例,其急性期的尿液LXA_(4)、TNF-α、β_(2)-MG、MA水平分别为(495.26±98.84)pg/ml、(1.99±0.48)μg/L、(0.59±0.22)mg/L、(18.66±5.21)mg/L,恢复早期的尿液LXA_(4)、TNF-α、β_(2)-MG、MA水平分别为(846.29±22.29)pg/ml、(1.11±0.12)μg/L、(0.29±0.08)mg/L、(10.26±1.49)mg/L;肾损害组治疗有效患儿恢复早期的尿液TNF-α、β_(2)-MG和MA水平均低于急性期,LXA_(4)水平高于急性期,差异具有统计学意义(P<0.05)。结论 TNF-α可能参与HSP及其肾损害的发病过程,尿液TNF-α水平增高可作为儿童HSP早期肾损害的判断指标之一,而LXA_(4)可能为肾脏保护因子,具有抗炎作用。

Objective To discuss the levels of urinary lipoxin A4(LXA_(4)) and tumor necrosis factor-a(TNF-a) in children with henoch-schonlein purpura(HSP) and their clinical significance.Methods 71 children with HSP were selected as the HSP group,and were divided into the renal injury group(35 cases)and the non-renal injury group(36 cases) according to the presence or absence of renal injury;30 children with healthy physical examination during the same period were selected as the control group.HSP group was given comprehensive treatment.Comparison was made on urinary LXA_(4) and TNF-α levels between the control group and the HSP group,between renal injury group and non-renal injury group;the efficacy of children in the HSP group was counted.Comparison was made on urinary LXA_(4) and TNF-α levels in children with different efficacy in the HSP group,the urinary LXA_(4) and TNF-α levels in children with effective treatment in the early recovery phase and the acute phase in the HSP group,and the urinary LXA_(4),TNF-α,β_(2) microglobulin(β_(2)-MG) and urinary microalbumin(MA) levels in children with effective treatment in the acute phase and the early recovery phase of the renal injury group.Results The urinary LXA_(4) and TNF-α in the HSP group were(494.35±102.65) pg/ml and(2.41±0.63) μg/L,which were higher than(262.15±100.51) pg/ml and(0.19±0.08) μg/L in the control group,and the differences were statistically significant(P<0.05).The urinary LXA_(4)(538.19±94.28) pg/ml in the non-renal injury group was higher than(449.26±98.84) pg/ml in the renal injury group,and the TNF-α(1.85±0.57) μg/L was lower than(2.99±0.48) μg/L in renal injury group,and the differences were statistically significant(P<0.05).In the HSP group,66 cases(92.96%) were effective and 5 cases(7.04%) were ineffective after treatment.In the HSP group,the urinary LXA_(4)(548.26±100.74) pg/ml in children with effective treatment was higher than(328.16±58.19) pg/ml in children without effective treatment,and the TNF-α(1.01±0.11) μg/L was lower than(1.79±0.38) μg/L in children without effective treatment,and the differences were statistically significant(P<0.05).For children with effective treatment in the HSP group,the urinary LXA_(4)(498.28±104.29) pg/ml in the acute phase was lower than(975.29±108.62) pg/ml in the early recovery phase,and the TNF-α(1.77±0.21) μg/L was higher than(1.05±0.18) μg/L in the early recovery phase,and the differences were statistically significant(P<0.05).There were 31 children with effective treatment in the renal injury group,and their urinary LXA_(4),TNF-α,β_(2)-MG,and MA levels were(495.26±98.84) pg/ml,(1.99±0.48) μg/L,(0.59±0.22) mg/L,and(18.66±5.21) mg/L in the acute phase,and(846.29±22.29) pg/ml,(1.11±0.12) μg/L,(0.29±0.08) mg/L,and(10.26±1.49) mg/L in the early recovery phase.For the children with effective treatment in the renal injury group,the urinary TNF-α,β_(2)-MG and MA levels in the early recovery phase were lower than those in the acute phase,and LXA_(4) levels were higher than those in the acute phase,and the differences were statistically significant(P<0.05).Conclusion TNF-α may be involved in the pathogenesis of HSP and its renal injury.Increased urinary TNF-α level can be used as one of the indicators of early renal injury in children with HSP.LXA_(4) may be a renal protective factor and has anti-inflammatory effect.