The Changes And Significances Of SFlt-1 And VEGF In Children With Henoch-sch(?)nlein Purpura And Henoch-sch(?)nlein Purpura Nephritis

ObjectiveTo explore the role of soluble fms-like tyrosine kinase receptor 1(sFlt-1)and vascular endothelial growth factor(VEGF)in children with Henoch-Sch?nlein purpura(HSP)and Henoch-Sch?nlein purpura nephritis(HSPN)and to explore new non-pouring indicators that can reflect kidney involvement of HSP and the pathological damage degrees of HSPN by measuring the values of sFlt-1 and VEGF in the serum of children and assessing their expressions in renal tissues of HSPN,aiming to provide evidences for severity assessment and treatment for HSPN.MethodsA study was performed at the First Affiliated Hospital of Zhengzhou University between May 2018 and January 2019.A total of 60 children who met the study criteria were enrolled,with 26 children in the HSP group and 34 children in the HSPN group.24 healthy children were chosen as the control group.The HSPN group were further divided into 3 subgroups:A group(grade II or below II,n=8);B group(grade IIIa,n=20);C group(grade IIIb or over IIIb,n=6).Additionally,para-carcinoma healthy renal tissues(>2cm away from the margins of tumors and confirmed no tumor cell infiltration by pathological examination)from 11 renal carcinoma children were chosen as control group of renal tissues.The levels of sFlt-1and VEGF in serum were measured by ELISA,the expressions of sFlt-1 and VEGF in renal tissues were assessed by immunohistochemistry.Data analyses were conducted using SPSS 22.0.Results1.The levels of sFlt-1 and VEGF in serumThere was a significant difference in the levels of serum sFlt-1 among HSP group,HSPN group and the normal control group(P<0.05).The serum sFlt-1 levels in the HSP group and the HSPN group are both significantly higher than that in the normal control group,and the serum sFlt-1 level in the HSPN group is significantly higher than that in the HSP group(P<0.05).Significant difference was also observed in the levels of serum VEGF among the three groups(P<0.05).The serum VEGF levels in the HSP group and the HSPN group are both significantly higher than that in the normal control group,and the serum VEGF level in the HSPN group is significantly higher than that in the HSP group(P<0.05).There was a significant difference in the levels of sFlt-1 in serum among the A group,B group and C group(P<0.05).The serum sFlt-1 level in the B group was significantly higher than that in the A group,and the indicator in the C group was significantly higher than that in the A group and the B group(P<0.05).Significant difference was demonstrated in the levels of VEGF in serum among the three groups(P<0.05).The serum VEGF level in the B group was significantly higher than that in the A group and the C group(P<0.05).However,no significant difference was observed in the levels of VEGF in serum between the A group and the C group(P>0.05).2.The expressions of sFlt-1 and VEGF in the renal tissuesThere was a significant difference in the expressions of sFlt-1 in the renal tissues among the A group,B group,C group and the normal control group(P<0.05).The expressions of sFlt-1 in the A group?B group and C group were significantly higher than that in the normal control group(P<0.05),and the expression in the B group was significantly higher than that in the A group(P<0.05);the expression in the C group was significantly higher than that in the A group and B group(P<0.05).There was also a significant difference in the expressions of VEGF in the renal tissues among the 4 groups(P<0.05).The expressions of VEGF in the A group?B group and C group were significantly higher than that in the normal control group(P<0.05).The expression of VEGF in the B group was significantly higher than that in the A group and the C group(P<0.05).No significant difference was detected in the expressions of VEGF in the renal tissues between the A group and the C group(P>0.05).3.Correlation analysisThe level of circulating sFlt-1 in the HSPN group correlated positively with the expression of sFlt-1 in renal tissues(r_s=0.849,P<0.05),so did the VEGF(r_s=0.721,P<0.05).No significant association existed between circulating sFlt-1 and circulating VEGF in the HSPN group(r_s=-0.130,P>0.05),neither did the expressions of sFlt-1and VEGF in renal tissues(r_s=-0.233,P>0.05).Neither sFlt-1 nor VEGF correlated significantly with urine protein quantification in 24 hours,white blood cells,C-reactive protein,D-dimer,or fibrinogen.Conclusion1.Abnormally elevated sFlt-1 and VEGF may play roles in the development of HSP and HSPN.2.The levels of sFlt-1 and VEGF in the serum can indirectly reflect the expressions of sFlt-1 and VEGF in renal tissues.3.Serum sFlt-1 can serve as an objective indicator of predicting and evaluating renal damage degrees in HSPN.