The Clinical Significance Of Lipoxin A₄ And Nuclear Factor Kappa B In Pediatric Henoch-Schonlein Purpura

Objective:To explore the clinical significance of Lipoxin A₄（LXA₄）and Nuclear factor kappa B（NF-κB）in the serum and urine of pediatric Henoch-Schonlein purpura（HSP）.Methods:207 HSP cases were recruited in this study,according to the clinical features,they were further divided into 3 groups:general HSP（GHSP）group consisted of 95 HSP without gastrointestinal（GI）involvement and nephritis,abdominal HSP（AHSP）group consisted of 60 HSP with GI involvement but without nephritis and Henoch-Schonlein purpura nephritis（HSPN）group consisted of 52 HSP with nephritis.Serum and morning urine samples were collected from each case during the acute phase and recovery period.Meanwhile,100 children with indirect inguinal hernia hernioplasty were selected as control group,and before the operation,their serum and morning urine specimens were collected as well.The levels of LXA₄ and NF-κB in each specimen were measured by enzyme-linked immunosorbent assay（ELISA）.The comparison of LXA₄ and NF-κB levels among the acute phase,recovery period of case group and control group were performed and among GHSP,AHSP,HSPN and control groups,the comparison of LXA₄ and NF-κB levels were performed,too.What’s more,the relationship between LXA₄and NF-κB were analyzed.In the meantime,the clinical and laboratory data of participants were obtained,levels of serum creatinine（SCr）,blood urea nitrogen（BUN）,24-hour urine protein and microalbuminuria（mAlb）were performed to determine their associations with LXA₄ and NF-κB.Results:（1）Serum and urine LXA₄ levels in the acute phase and recovery period of cases were significantly higher than the controls（P all<0.01）,and the LXA₄ levels in the recovery period were higher than the acute phase（P all<0.01）.Serum and urine NF-κB levels in the acute phase of cases were markedly higher than the recovery period of cases（P all<0.01）and controls（P all<0.01）,however,there was no significant difference in NF-κB levels between the recovery period of cases and controls（P all>0.05）.In the cases,levels of LXA₄ and NF-κB in serum were significantly higher than those in urine（P all<0.01）,but in the controls,there was no significant difference of LXA₄ and NF-κB levels between serum and urine（P all>0.05）.（2）In the acute phase,the LXA₄ levels in the serum and urine of GHSP and AHSP groups were significantly higher in comparison with HSPN group（P all<0.01）and controls（P<0.01,P<0.05）,and LXA₄ levels in GHSP group were higher than AHSP group（P all<0.01）,but no significant difference was found between HSPN group and the control group（P all>0.05）.The NF-κB levels in serum and urine of GHSP,AHSP and HSPN groups were all markedly higher than the control group（P<0.01,P<0.05）,NF-κB levels in HSPN were higher than GHSP（P all<0.01）and AHSP groups（P all<0.01）and NF-κB levels in AHSP were higher than GHSP group（P all<0.01）.（3）In the recovery period,the LXA₄levels in the serum and urine of GHSP and AHSP and HSPN groups were significantly higher than the control group（P<0.01,P<0.05）,and LXA₄ levels in GHSP group were higher than AHSP group（P all<0.01）and HSPN group（P all<0.01）,LXA₄ levels in AHSP group were higher than HSPN group（P<0.01,P<0.05）,but there was no significant difference in the NF-κB levels between GHSP,AHSP,HSPN and the control groups（P all>0.05）.（4）In the acute phase,the LXA₄ levels in serum and urine of non-HSPN group were significantly higher in comparison with HSPN group（P all<0.01）and the NF-κB levels were markedly lower than HSPN group（P all<0.01）.（5）In the recovery period,the LXA₄ levels in serum and urine of non-HSPN group were significantly higher than HSPN group（P all<0.01）,but there was no significant difference in the NF-κB levels between non-HSPN and HSPN groups（P all>0.05）.（6）In the acute phase of cases,the levels of serum LXA₄ correlated negatively with serum NF-κB（r=0.290,P<0.01）,and in the urine,the LXA₄ levels correlated negatively with NF-κB as well（r=0.286,P<0.01）.（7）In the acute phase of HSPN group,24-hour urine protein and mAlb were inversely associated with the serum and urine levels of LXA₄（P<0.01,P<0.05）,whereas had no relationships with NF-κB（P all>0.05）.Additionally,SCr and BUN had no relationships with LXA₄ and NF-κB（P all>0.05）.Conclusions:LXA₄ and NF-κB may be involved in the development of HSP and correlated with the severity of disease.LXA₄ may play an important protecting role in HSP renal lesion and insufficient level of LXA₄ may indicate the renal involvement.Monitoring the serum and urine levels of LXA₄ could provide valuable information for early evaluation of renal damage and instructing therapy in children with HSP.