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目的检测过敏性紫癜(HSP)患儿血浆血栓调节蛋白(TM)、血管性假血友病因子(vWF)、基质金属蛋白酶-9(MMP-9)水平,探讨它们在HSP发病机制中的作用及与紫癜性肾炎(HSPN)的关系。方法2006-09—2007-02在青岛大学医学院附属烟台毓璜顶医院儿内科住院的HSP患儿46例,应用酶联免疫吸附试验(ELISA)检测HSP患儿急性期(46例)、缓解期(40例)及健康对照儿童(20例)血浆TM、vWF、MMP-9水平。结果HSP患儿急性期TM、vWF、MMP-9水平明显高于对照组(P均<0.01),也高于缓解组(P均<0.05)。MMP-9下降较缓慢,在恢复期仍显著高于对照组(P=0.01)。伴肾受累组vWF、MMP-9高于非肾受累组(P均<0.05),而TM在两组之间差异无显著性意义(P>0.05)。TM、vWF浓度之间成直线正相关,而TM、vWF分别与MMP-9之间相关性分析无统计学意义。结论血管内皮细胞及细胞外基质损伤在HSP的发病机制中起着重要的作用,血浆TM、vWF、MMP-9水平测定有助于了解病情活动及判断是否合并肾脏损害,动态测定有助于观察病情演变及指导治疗。
Objective To investigate the levels of plasma thrombomodulin (TM), von Willebrand factor (vWF) and matrix metalloproteinase-9 (MMP-9) in children with Henoch-Schonlein purpura (HSP) and their roles in the pathogenesis of HSP And purpura nephritis (HSPN). METHODS: Forty-six patients with HSP were hospitalized in Yantai Yuhuangding Hospital, Qingdao University Medical College from September 2006 to February 2007. Enzyme linked immunosorbent assay (ELISA) was used to detect the acute phase (46 cases), the remission stage 40 cases) and healthy control children (20 cases) plasma TM, vWF, MMP-9 levels. Results The levels of TM, vWF and MMP-9 in acute stage of HSP were significantly higher than those in control group (all P <0.01), and also higher than those in remission group (all P <0.05). MMP-9 decreased more slowly, still significantly higher in the recovery period than the control group (P = 0.01). The vWF and MMP-9 levels in patients with kidney involvement were higher than those in non-kidney patients (all P <0.05), but there was no significant difference in TM between the two groups (P> 0.05). There was a linear positive correlation between TM and vWF concentrations, but the correlation between TM and vWF and MMP-9 was not statistically significant. Conclusion Vascular endothelial cells and extracellular matrix injury play an important role in the pathogenesis of HSP. The levels of plasma TM, vWF and MMP-9 are helpful to understand the disease activity and to judge whether renal damage is involved. Dynamic measurement is helpful to observe Disease evolution and guidance and treatment.