| Background and ObjectiveHenoch-Schonlein purpura (HSP) is the most common systemic vasculitis disease in children. Descriptions of purpura、arthritis、gastrointestinal and renal involvement are recognized in HSP. Henoch-Schonlein purpura nephritis (HSPN) is HSP with renal involvement. HSPN is a common secondary glomerulonephritis in children. HSPN is persistent and is one of the main reasons for chronic renal failure in childhren. The kidney damage degree determines the long-term prognosis of HSP.So far, the pathogenesis of HSP and HSPN is not very clear yet. Many studies have shown that emergence of hypercoagulable states and anticoagulant fibrinolytic disorders would happen in the pathogenesis of HSP and HSPN, which have achieved the better curative effect through the use of anticoagulant treatment. Antithrombin III (AT-Ⅲ) is one of the most important physiological inhibitor in human body and the activity of AT-ⅢII (ATⅢ-%) in the plasma may reflect the activation of the anticoagulation system. In recent years, the study results are not uniform about AT-Ⅲ, which is less in the different course of disease in children with HSP. Meanwhile, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1(PAI-1) maintain the balance of the fibrinolytic system and anti-fibrinolytic system, and participate in the metabolism of the extracellular matrix. In recent years, scholars believe that correlation exists between the expression imbalance of t-PA and PAI-1and Kidney damage of IgA nephropathy, chronic glomerulonephritis, acute renal failure and other diseases. However, the studies of t-PA and PAI-1in children with HSP and HSPN are relatively little, which are less in the different course of disease.In this study, we investigated activities of antithrombin-Ⅲ (ATⅢ-%), plasma levels of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-l(PAI-l), D-dimer (D-D), fibrinogen degradation product (FDP) and urine total protein of24hours (24U-TP) in different course of HSP, HSPN and controls. The aim of the present study was to observe the changes of elevated markers of anticoagulation fibrinolytic system in children with HSP and HSPN in different course, and to explore the correlation between the changes of elevated markers of anticoagulation fibrinolytic system with the occurrence and progression of disease in children with HSPN, and to provide some basis to the pathogenesis and clinical treatment of HSP and HSPN.Methods100children with HSP,141children with HSPN and35healthy children were entered into study. Based on course of disease, the children with HSP were divided into four groups:the first group (n=30), the second group (n=27), the third group (n=23), the fourth group (n=20), and the children with HSPN were divided into six groups:the first group (n=19), the second group (n=22), the third group (n=28), the fourth group (n=21), the fifth group (n=22), the sixth group (n=29). The first group include cases who have symptoms of purpura、arthritis、gastrointestinal initially or repeatedly. The second group is defined as clinical symptoms subsided last two weeks. The third group is defined as clinical symptoms subsided last two weeks to one month. The fourth group is defined as clinical symptoms subsided last one month to two months. The fifth group is defined as clinical symptoms subsided last two months to three months. The sixth group is defined as clinical symptoms subsided last three months to six months. Because the number of cases is less in children with HSP without renal involvement whose clinical symptoms subsided last two months or longer, so these were not investigated.Activities of antithrombin-III (ATⅢ-%), plasma levels of D-dimer (D-D) and fibrinogen degradation product (FDP) were detected by immunoturbidimetric assay. Plasma levels of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1(PAI-1) were detected by enzyme-linked immunosorbend assay (ELISA). Urine total protein of24hours (24U-TP) was detected by sulfosalicylic acid-sodium sulfate (SS-S).Results1. To compare research indicators of the children with HSP to controls in different groupAll research indicators in children with HSP were significantly higher than those of the controls in first group.(P<0.05). As the extension of the course, plasma levels of t-PA and PAI-1reduced gradually, D-D and FDP levels reduced to normal in second group and ATⅢ-%levels reduced to normal in forth group (P>0.05).2. To compare research indicators of the children with HSPN to controls in different groupAll research indicators in children with HSPN were significantly higher than those of the controls in first group (P<0.05). As the extension of the course, plasma levels of t-PA and PAI-1reduced gradually, t-PA/PAI-1increased gradually, D-D and FDP levels reduced to normal in second group, and ATⅢ-%levels reduced to normal in sixth group (P>0.05).3. To compare research indicators of the children with HSPN to HSP in first groupATⅢ-%and PAI-1levels in patients with HSPN were significantly higher than those in patients with HSP during in first group (P<0.05). T-PA and t-PA/PAI-1levels in patients with HSPN were significantly lower than those in patients with HSP in first group (P<0.05). No difference was found between HSP and HSPN about D-D and FDP levels in first group (P>0.05).4. To find correlation of research indicators in the children with HSPNA significant correlation was detected between24U-TP and ATⅢ-%levels in patients with HSPN (r=0.497, P<0.001). A significant correlation was detected between24U-TP and t-PA/PAI-1levels in patients with HSPN (r=-0.307, P<0.001).Conclusions1. The patients with HSP and HSPN had activation in their anticoagulation fibrinolytic system in the early course of the disease, which reduce gradually as extension of the course.2. A correlation may be there between ATⅢ-%and the occurrence of disease in children with HSPN.3. Impairment of the fibrinolytic system is related to the kidney damage in children with Henoch-Schonlein Purpura. |
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