| Objective: Purpura, also known as Hengshu syndrome (with Henochschonlein purpura, HSP) is a common immune-related connective tissuediseases in school-age children, crossponding microvascular inflammatoryresponse.Lesions involvs multiple organs and tissues of the skin, joints,gastrointestinal tract and kidneys,and which manifested as skin purpura, jointpain, abdominal pain and blood in the stool and hematuria and proteinuria.Kidney damage is one of the basic performance and also it animportant factor affecting the HSP prognosis. Reports indicated that thekidney damage caused by the allergic purpura, Henoch-Schonlein purpuranephritis (HSPN) is25~80%. It seriously affected the prognosis of children.Pathogenesis of HSP has not yet been fully elucidated, but the majorityincentives, such as infection or allergic reactions and abnormal blood clottingmechanism affeced the patients. According to research, humoral immunityor cellular immunity, a variety of cytokines with the participation ofinflammatory mediators were involved in the disease.At the normal physiological conditions, the urine contains a amount typesof trace protein, including ALB, NAG, β-2MG and so on. When kidneydamage caused by certain diseases occurs, the dose of these proteins willincrease in the urine.The urinary albumin (ALB), is a polymer micro protein. It is one of theearly sensitive indicators which indicates the impairtion of renal glomerulus.Albumin is the smallest protein which could pass the glomerular filtrationmembrane and reabsorped in the renal proximal convoluted tubule. When theglomerular injury due to the infection or other external factors occures, the glomerular filtration rate decreased. Then the albumin and urinemicroalbumin could be evalued in urine. The urine microalbumin in the earlykidney damage caused by hypertension and diabetes is increamental. And alsoit can serves as an indicator of disease activity.C-reactive protein (CRP), is an acute phase protein in the human bodysynthesised by liver cells. In vivo concentration change is closely related toinfection, inflammation, injury. It is a non-specific inflammatory markers inhuman body. It is supposed that CRP are related with interleukin-6, tumornecrosis factor, monocyte chemoattractant protein and so on. And it canmediated the inflammatory response in small blood vessels of HSP. It isreported that the synthesis of CRP is increased in hepatic cells. And whenthe inflammation is controlled, the level of CRP rapidly returned to normal.And it is also reported that serum IL-10, IL-15and CRP exist significantcorrelation in HSP patient in acute phase.Platelet (PLT) only exists in mammals, the present study found that it iscreated by megakaryocytes in the bone marrow hematopoietic tissue.Multi-functional hematopoietic stem cells directed differentiation intoprimitive megakaryocyte in hematopoietic tissues, and then further into maturemegakaryocytes. Mature megakaryocyte cells surface is formed of manydepressions, stretching into the cytoplasm. the adjacent cell membrane mergedin the deep depression, so part of the cytoplasm of megakaryocytes separatesfrom maternal. And then these composition surrounded by the cellmembrane and separated from the cytoplasm of megakaryocytes breaks awayfrom the megakaryocytes, and then they become platelets when they enter theblood circulation after the sinusoids in the bone marrow hematopoietic tissue.It plays an important role in physiological and pathological processes, such ashemostasis, wound healing, inflammation, thrombosis and so on. Recently,more and more data show that activated platelets may participate in tissuerepair of chronic disease, platelets can also involved in immune responses andpromote inflammation as an endogenous inflammatory cells. It was found thatthe platelet activation in children with HSPN is high, suggesting that platelet activation is an important part in the development and progression ofHSP. Platelets release biologically active substances, including vasoactiveamines, vasoactive ester, platelet-derived growth factor, cytokines, proteases,procoagulant substances. Platelet-derived growth factor (PDGF) can promotecell division, increase cell proliferation, and then eventually lead to glomerularmesangial cell proliferation. Experiments has confirmed that PDGF in serumof HSPN children after heparin therapy was significantly lower than beforetreatment.The level of CRP and PLT in serum and the level of mALB in urine ofthe HSPN children with upper respiratory infection changes as the diseaseoutcome varies, suggesting that this three factors have some certain value inthe monitor and prognosis of disease of HSP and HSPN. corticosteroids andimmunosuppressive agents are the major treatment of HSP and HSPN. Theprevention and treatment of purpura nephritis (HSPN) with Heparin andanti-platelet aggregation drug are rarely reported. And it has not yet beenreported for the effection of the upper respiratory infection to theconvalescence of the HSPN. This study will detect the dynamic expression ofPLT, CRP in serum and the ALB in urine of the convalescenc of HSPN withupper respiratory tract infection. And to explore the significance of the relatedfactors in the diagnosis, treatment and prognosis of HSPN. And it plays aguiding role in clinical use of drugs too.Methods:1The selection of subjectsIn this study, subjects were diagnosed with HSPN, referenced todiagnosis and treatment of Evidence-Based Guide (Trial)(simplified as the"Trial Implementation Guide) of the purpura nephritis, enacted in2009by theChina Medical moment Sciences Branch of nephrology group, that is, in thecourse of allergic purpura months, hematuria and (or) proteinuria. Diagnosticcriteria for hematuria and proteinuria, respectively, as follows:(1) hematuria:gross hematuria or microscopic hematuria; proteinuria (2): any of thefollowing:①the positive urine protein must be at least3times in1week; ②urinary protein quantitative>150mg in24h;③the urine albumin must behigher than the upper limit of normal at least3times with in1week. Theguide is proposed to strive for renal biopsy when allergic purpura last for6months or longer occurrence of kidney damage in children, such as mesangialproliferative glomerulonephritis, which is deposited with IgA mesangial. Andalso diagnosed as purpura nephritis. Although97%of children with renalimpairment occurred within6months, but the type of kidney damage, whichoccurred relatively long time in children must be diagnosed carefully in orderto avoid misdiagnosis of other kidney disease. And all children are throughformal clinical treatment.2Research ProgrammeAll selected children are clear in the clinical diagnosis of purpuranephritis,(reference purpura nephritis, diagnosis and treatment ofevidence-based guidelines developed by the China Medical moment SciencesBranch of nephrology group in2009), and the after treatment of blood routine,urine routine, and urinary microalbumin albumin are all back to normal for atleast a week. And then upper respiratory tract infection shows the symptoms.The innitial treatment of Upper respiratory tract infection is used as early stage,treatment after two weeks is used as middle stage, treatment after four weeksis used as late stage.3Detection methods3.1Detection of PLTCinical test data comply with the requirements of this study of childrenwith blood PLT should be collected.3.2The CRP with dry-type quantitative immunofluorescence method(i-CHROMA Reader)Balance the reaction plate and assay buffer for10minutes at roomtemperature, draw the sample10μl buffer tube, mix well5times, draw themixture to the sample hole of the plate at room temperature for3minutes, setthe i-CHROMA Reader instruments, waiting to be scanned, read the data. 3.3Urinary albumin using ELISA double antibody sandwichStandard dilution and add sample, incubation, incubation, seal platemembrane plate and then home at37℃for30minutes, with liquid, washedfive times, pat dry, enzyme standard: each hole by adding the enzyme reagent50μl, except for blank wells, repeated incubation and washing, dark colorationfor15minutes at37°C, terminate the reaction (when the blue turn to yellow),determine: blank wells zero,450nm wavelength sequentially measures theabsorbance of each well (OD),calculate the concentration of the target proteinaccording to the formula.4Statistical analysisData statistics applicate the SPSS Statistics17.0database, the data usingnon-parametric test for two related samples (Wilcoxon test), χ2test, we canconsider that difference was statistically significant when P <0.05.Results:1The expression of mALB in the urine of the HSPN convalescence with theupper respiratory infections in children and the relationship betweenexpression of mALB and and gender1.1The expression of mALB in the urine of the HSPN convalescence with theupper respiratory infections in childrenThe expression of the of mALB in HSPN convalescenc with therespiratory tract infection in children when onset, treatment2weeks and4weeks after treatment,: the expression of urine mALB gradually decreased, thenumber of treatment after two weeks (42.18mg/L (M))significantlydecreasead compared with onset(67.24mg/L (M)), the number of treatmentafter4weeks (27.38mg/L (M)) is significantly lower than2weeks later, thestatistically are significant (p <0.05).1.2The relationship between expression of mALB and and genderThe abnormal expression rates of mALB in the urine of male and femalechildren,in the initial issuance, treatment after two weeks and treatment after4weeks are not significantly related (p>0.05). 2The expression of CRP in the serum of the HSPN convalescence with theupper respiratory infections in children and the relationship betweenexpression of mALB and and gender2.1The expression of CRP in the serum of the HSPN convalescence with theupper respiratory infections in childrenThe expression of the of CRP in HSPN convalescenc with the respiratorytract infection in children when onset, treatment2weeks and4weeks aftertreatment,: the expression of serum CRP gradually decreased, the number oftreatment after two weeks (16.86mg/L (M))significantly decreaseadcompared with onset(28.33mg/L (M)), the number of treatment after4weeks (6.27mg/L (M)) is significantly lower than2weeks later, thestatistically are significant (p <0.05).2.2The relationship between expression of CRP and and genderThe abnormal expression rates of CRP in the serum of male and femalechildren,in the initial issuance, treatment after two weeks and treatment after4weeks are not significantly related (p>0.05).3The expression of PLT in the serum of the HSPN convalescence with theupper respiratory infections in children and The relationship betweenexpression of PLT and and gender3.1The expression of PLT in the serum of the HSPN convalescence with theupper respiratory infections in childrenThe expression of the of PLT in HSPN convalescenc with the respiratorytract infection in children when onset, treatment2weeks and4weeks aftertreatment,: the expression of serum PLT gradually decreased, the number oftreatment after two weeks (339.50×109/L (M))significantly decreaseadcompared with onset(459.00×109/L (M)), the number of treatment after4weeks (287.80×109/L (M)) is significantly lower than2weeks later, thestatistically are significant (p <0.05).3.2The relationship between expression of PLT and and genderThe abnormal expression rates of PLT in the serum of male and femalechildren,in the initial issuance, treatment after two weeks and treatment after 4weeks are not significantly related (p>0.05)Conclusions:1The expression of the urine mALB after treatment of the HSPNconvalescenc with upper respiratory tract infection in children are better thanbefore treatment. And the number is near to normal after four weekstreatment.2The expression of the serum CRP after treatment of the HSPN convalescencwith upper respiratory tract infection in children are better than beforetreatment. And the number is near to normal after four weeks treatment.3The expression of the serum PLT after treatment of the HSPN convalescencwith upper respiratory tract infection in children are better than beforetreatment. And the number is back to normal after four weeks treatment.4There are no significantly relationships between mALB,CRP and PLT andgender during the four weeks treatment of the HSPN convalescenc with upperrespiratory tract infection in children.5These results suggest that mALB, CRP and PLT can be used as a barometerof the treatment of children HSPN convalescenc with upper respiratory tractinfection.6The data changes of this subject shows that when the HSPN recovery periodwith upper respiratory tract infection occurs, the kidney damage appears again.The possible mechanism is infection causes the body to re-immune disorders,leading to immune complex deposed in the kidney, causing kidney damage.7the data change in this subject shows that kidney damage caused by HSPNconvalescence with upper respiratory tract infection gradually recovered afterfour weeks of treatment, nearly back to normal. |
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