The Clinical Significances Of Connective Tissue Growth Factor And Collagen Ⅳ In Children With Henoch-Schonlein Purpura

Investigation background and objective:Henoch-Schonlein purpura nephropathy(HSPN)is one of the major complications of Henoch-Schonlein purpura(HSP)and an important cause of death in this patients.The pathological hallmarks of HSPN are mesangial cell proliferation and extracellular matrix(ECM)accumulation,which lead to increased thickness of the glomerular and tubular basement membrane(GBM)and mesangial expansion,and finally result in glomerulosclerosis and loss of the renal function.These mainlu result from an imbalance between the synthesis and degradation of ECM.CollagenⅣis one of the most important components of ECM,and CTGF may play an important role in the synthesis of ECM,and in glomerulosclerosis.Studies have shown that CollagenⅣand CTGF are involved in the pathogenesis of some renal diseases.But their effects on the development and progression of HSPN have not been fuly explored.The present study was designed to investigate the serum/urinary levels of CTGF and CollagenⅣ,and evaluate their clinical significances in children with HSP.Methods:85children of Henoch-Schonlein purpura were divided into three groups according to urinary albumin excretion rate(UAER):normal albuminuric group:＜20μg/min(groupⅠ,N=25);microalbuminuric group:20～200μg/min(groupⅡ,N=31):macroalbuminuric group＞200μg/ min(groupⅢ,N=29).The serum/urinary levels of CTGF and CollagenⅣwere determined by ELISA.Results:1.The serum level of the CTGF in groupⅢwas markedly higher than that in healthy controls(P＜0.05).However,there were no defferences among groupⅠ,groupⅡand healthy controls(P＞0.05).The urinary levels of the CTGF in children with HSP were markedly higher than that in healthy controls(P＜0.05),moreover,the urinary level of CTGF was increased with UAER and there were significant differences among the three groups(P＜0.05).2.The serum levels of the collagenⅣin children with HSP were markedly higher than that in healthy controls(P＜0.05),moreover,the serum levels of the CTGF in children with HSP were increased with UAER,and there were significant differences among the three groups(P＜0.05).The urinary levels of the collagenⅣin children with HSP were markedly higher than that in healthy controls(P＜0.05),moreover,the urinary levels of the collagenⅣin children with HSP were increased with UAER,and there were significant differences among the three groups(P＜0.05).3.There were no correlations between serum CTGF and urinary CTGF,serum collagenⅣ,UAER(P＞0.05),urinary CTGF was positively correlated with that of collagenⅣ,UAER(p＜0.01).Serum collagenⅣwas also positively correlated with urinary collagenⅣ,UAER(p＜0.01).Urinary collagenⅣwas positively correlated with UAER(P＜0.01).Conclusion:1.CTGF might play a very important role in the development of HSPN.The urinary level of CTGF,but not serum level of CTGF,could be an early marker for predicting HSPN.2.CollagenⅣmight play a very important role in the development of HSPN.Serum level of the collagenⅣand urinary level of the collagenⅣcould be used for earlier diagnosis of HSPN than UAER.As a noninvasive clinical marker,the measurement of urinary collagenⅣwas useful in diagnosis and understanding pathologic changes and severity of HSPN.3.The overexpression of CTGF protein might be one of the mechanisms of HSPN.Searching out the effect of CTGF might be helpful for the prevention and treatment of HSPN.