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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～1 a,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。
Objective To investigate the value of plasma thrombomodulin (TM), von Willebrand factor (vWF), and matrix metalloproteinase-9 (MMP-9) in the early diagnosis of HSP in children with Henoch-Schonlein purpura (HSP) Methods Plasma levels of TM, vWF and MMP-9 in 60 healthy children (control group) and 160 children with HSP were detected by ELISA. Six cases were followed up from 6 months to 1 year, 62 cases of renal damage and 98 cases of non-renal damage were divided into group A: isolated hematuria (18 cases) or isolated proteinuria (3 cases); group B: Hematuria + proteinuria (29 cases); Group C: massive proteinuria (12 cases). The changes of each value in kidney damage group, non-kidney damage group and healthy control group were compared, and the differences in different groups of kidney damage were compared. Results 1. The levels of TM (148.13 ± 18.60) mg.L-1, vWF (159.50 ± 23.06)%, MMP-9 [36.53 ± 7.86 mg.L-1] (129.49 ± 21.22) mg.L-1, (136.98 ± 25.48)% and (29.14 ± 8.17) mg.L-1, respectively, and those in the healthy group [(113.63 ± 20.88) mg.L- ± 24.69%, (24.37 ± 7.34) mg.L-1], respectively, with significant difference (Pa <0.05). There was no significant difference between the non-renal impairment group and the healthy control group (Pa> 0.05). In renal injury group, the levels of vWF (169.45 ± 23.36)% and (160.20 ± 21.46)% in group C and group B were significantly higher than those in group B (158.59 ± 17.80 mg.L-1, 149.72 ± 19.20 mg.L- (131.28 ± 16.14) mg.L-1, (139.59 ± 19.26)%, MMP-9 (42.66 ± 6.31) mg.L-1 and 35.88 ± 7.33 mg.L- (P <0.05). The level of MMP-9 in group C was higher than that in group B (P <0.05), and the difference was statistically significant There was no significant difference in vWF between the two groups (Pa> 0.05). Conclusions TM, vWF and MMP-9 are elevated in the acute stage of HSP, which can be used as an index to predict renal damage in the early stage. Combined detection is helpful to predict the occurrence of renal damage and the degree of renal damage in the early stage.