Determination And Significance Of Tm And Cec In Children With Henoch-schonlein Purpura

Henoch-schonlein purpura(HSP) is a most common diseases of vascular inflammatory in childhood,and is characterized by non-thrombocytopenic purpura. HSP can be associated with gastrointestinal symptoms,join pain and kindey damage. Capillary wall is mainly involved,the pathological changes of HSP are acute aseptic of the inflammatory response in a wider range of capillaries and small arteries,and may be the focal necrosis of capillary walls,cellulose deposition.Vascular endothelial cells are a direct target organ damage in the pathological process of vascular inflammation,and the first part in vascular damage.Capillary-rich kindey is one of its major organ involvement,the renal vascular disease and renal dysfunction have a significant correlation,so determination of plasma markers of endothelial cell injury in the surface of inflammatory mediators and markers of specific concentrations may be reveal the pathogenic mechanism of Henoch-Schonlein purpura,treatment effect of Henoch-Schonlein purpura and the assessing progress of kidney injury for HSPN.Thrombomodulin(TM),the receptor of thrombin,is one of the transmemberane glycoprotein on the surface of endothelium.TM is one of the most important members of protein C.Protein C plays an important role in the anticoagulation system in the blood and is activated by thrombin.When coagulation system is activated,large amounts of thrombinogen are activated into thrombin.After production,thrombin can also combin with its receptor which is TM on the surface of endothelium,then its effect to activate PC can be promoted by more than 1000-20000 times.TM fallen from endothelium only has weak effect,so it is regarded as one of the important factors of partial anticoagulation.Because TM distributes mainly on the endothelial surface of arteries,veins and capillaries,et al,people consider it as one of biochemical marker of endothelial injuries.In normal conditions,there is only a low concentration of TM in the blood,but it will increase if endothelial is widely damaged.The degree of the increase is postulated parallel to the range and degree of the endothelium damages.And circulating endothelial cell(CEC) in blood derives from vascular endothelial cell(VEC),and it is specific withal direct marker of vascular endothelial cell injury in vivo.At abnormal state,due to suffering from patho-stimulus of physics, chemistry as well as organism VEC injures,that shows a great quantity of VEC fall off and enter blood and EC functional disorder,thus leads to the number of CEC in blood increasing obviously.Recent years,following to researching on endothelial cell, the relationships between diseases and VEC injury are to be reconstructed increasingly.It has been recognized that VEC injury is the basic pathology process in the onset and development of many diseases.The objective of this study was to observe TM which is one of biochemical marker of vascular endothelial injuries and one of the important factors of anticoagulation and CEC which is specific withal direct marker of vascular endothelial cell injury in vivo in the patients with HSP,to discussing the relation of TM,CEC and the pathogenic mechanism,assessing progress,prognosis and determining proper treatment for HSP,and assessing progress of kidney injury for HSPN.TM and CEC may be used as indexes of the assessing progress of kidney injury for HSPN.[Method]1 HSP disease group:To select 71 cases in pediatrics department of the first affiliated hospital of Zhengzhou university,including 48 boys and 23 girls.HSPN disease groups: hematurin,hematurin and proteinuria,abundant proteinuria(protein of 24 hours urine≥50mg/kg).Normal control group:30 normal children who go to the hospital for health examination,including 21 boys and 9 girls.2 Thrombomoduhn(TM) was measured by enzyme-linked immuno sorbent assay (ELISA) methord in SHP patients and healthy controls. 3 Thrombomoduhn(TM) in kidney of HSPN was measured by immunohistochemical SP technique,the results evaluated by Biosens Digital Imaging system.4 Circulating endothelial cell(CEC) was measured by flowcetometry method in SHP patients and healthy controls.5 Albumin(A),Blood urea nitrogen(BUN),Serum creatinine(Scr),Fibrinogen(Fbg), Protein of 24 hours urine,urineβ-N-acetyglocosamidase(NAG),urineβ₂-microglobulin (β₂-MG) and kidney tissue of HSPN pathology come from the first affiliated hospital of Zhengzhou university.6 Statistical analysis:All the data were analyzed by SPSS13.0 statistical software package.All data were expressed as mean±standard deviation.The comparison of counting data by t test;correlation analysis by Pearson's correlation;the level of significant difference was a=0.05.[Result]1 TM in acute HSP patients was significantly higher than in healthy controls (P＜0.01).2 TM in HSPN patients was significantly higher than in HSP patients(P＜0.05).3 TM in recovery HSPN patients was significantly higher than in recovery HSP patients(P＜0.05).4 TM in HSPN patients with hematurin and proteinuria was significantly higher than in HSPN patients with hematurin(P＜0.05);TM in HSPN patients with abundant proteinuria was higher than in HSPN patients with hematurin and proteinuria (P＞0.05);TM in HSPN patients with abundant proteinuria was significantly higher than in HSPN patients with hematurin(P＜0.05).5 There was negative correlation between TM and A(r=-0.456,P＜0.01);There was positive correlation between TM and BUN(r=0.372,P＜0.01);There was positive correlation between TM and Scr(r=0.328,P＜0.01);There was positive correlation between TM and urine NAG(r=0.381,P＜0.01);There was positive correlation between TM and urineβ₂-MG(r=0.285,P＜0.05);There was positive correlation between TM and Fbg(r=0.478,P＜0.01).6 The expression of TM was positive in kidney of HSPN,there was positive correlation between TM in plasma and TM in kindey(r=0.771,P＜0.01).7 CEC in acute HSP patients was significantly higher than in healthy controls (P＜0.05).8 CEC in HSPN patients was higher than in HSP patients(P＞0.05).9 CEC in recovery HSPN patients was significantly higher than in recovery HSP patients(P＜0.05).10 CEC in HSPN patients with hematurin and proteinuria was significantly higher than in HSPN patients with hematurin(P＜0.05);CEC in HSPN patients with abundant proteinuria was higher than in HSPN patients with hematurin and proteinuria(P＞0.05);CEC in HSPN patients with abundant proteinuria was significantly higher than in HSPN patients with hematurin(P＜0.05).11 There was negative correlation between CEC and A(r=-0.264,P＜0.05);There was positive correlation between CEC and Scr(r=0.260,P＜0.05);There was positive correlation between CEC and urine NAG(r=0.443,P＜0.01);There was positive correlation between CEC and urineβ₂-MG(r=0.277,P＜0.05);.12 There was positive correlation between TM and CEC(r=0.426,P＜0.01).[Conclusion]1 Vascular endothelial damages may be a important factor in the pathogenesis of HSP.2 TM and CEC are of great value in assessing progress of kidney injury for HSPN.3 TM and CEC are of great value in assessing progress and prognosis and determining proper treatment for HSP.4 there was positive correlation between TM in plasma and TM in kidney,so coagulation in blood of circumference and in kindey are parallel.