Variation And Clinical Significance Of Circulation SEPCR In Patients With Different Pathological Types Of Common Primary Glomerular Disease

Objective Compare the plasma levels of soluble endothelial cell protein C receptor(sEPCR) and von Willebrand Factor (vWF),interleukin-6(IL-6) in patients with differentpathological types of common primary glomerular disease and in normal control group, toexplore the significance of sEPCR in different pathological types of common primaryglomerular disease.Methods From May2010to December2011,66cases of common primary glomerulardisease patients who were hospitalized in the nephrology department of the First AffiliatedHospital of Soochow University and diagnosed by renal biopsy including15cases of IgAnephropathy (IgAN),15cases of membranous nephropathy (MN),13cases of focalsegmental glomerulosclerosis (FSGS),11cases of mesangial proliferativeglomerulonephritis (MsPGN),12cases of minimal change disease (MCD) were enrolled inthis study,20cases of normal controls (NC) were also enrolled. The level of plasmasEPCR, IL-6and vWF were measured by the enzyme-linked immunosorbent assay(ELISA); The blood pressure and other subjects were measured also; Fasting venous bloodsamples were extracted to detect platelet(PLT), hemoglobin(HGB), serum creatinine(SCr),cholesterol(TC), albumin(ALB), C-reactive protein(CRP), prothrombin time(PT), activatedpartial thromboplastin time(APTT), D-dimer(D-Dim); Urinary protein in24hours wasdetected by biuret colorimetry.Results1The plasma level of sEPCR in MN group was significantly higher than that ingroups of IgAN, FSGS, MsPGN (P<0.05); but had no significant difference with MCDgroup (P>0.05). The level of vWF in MN group was also significantly higher than that inother groups (IgAN, FSGS, MsPGN, MCD)(P<0.05).2The plasma level of IL-6in MsPGN group was significantly higher than that ingroups of IgAN, MN, FSGS and MCD (P<0.01); and compared with FSGS group,the level of IL-6in groups of IgAN, MN and MCD were significantly lower (P<0.01).3For clinical classification, compared with latent nephritis group, the plasma levels ofsEPCR in nephrotic syndrome group was significantly higher (P<0.05); the level of vWFin nephrotic syndrome group was also significantly higher than that in rapidly progressiveglomerulonephritis group (P<0.05); the plasma levels of IL-6in rapidly progressiveglomerulonephritis group was significantly higher than that in other groups (latentnephritis group, chronic glomerulonephritis group, nephrotic syndrome)(P<0.05).4As for sEPCR in common primary glomerular disease patients with differentpathological types, a positive correlation was found with vWF (r=0.423, P<0.01),IL-6(r=0.214，P<0.05), D-dimer (r=0.340, P<0.05), urinary protein in24hours (r=0.540,P<0.01), CRP(r=0.295，P<0.05)，negtive correlation was found with blood albumin(r=-0.330, P<0.01), no correlation was found among APTT, TT, FIB, AT-III, PLT, SCr. Asfor IL-6, a positive correlation was found with CRP (r=0.335, P<0.01), but both IL-6andCRP had no correlation with SCr.Conclusion1A positive correlation between plasma level of sEPCR and vWF in primaryglomerular disease patients suggest the sEPCR as an indicator of endothelial cell damage.The significantly increased level of plasma sEPCR in all the patients with differentcommon pathological types of primary glomerular disease present an importantpathophysiological satates about the endothelial cell injure,and it may be involved in thethe progression of the primary glomerular disease, and contribute to understanding thepathogenesis.2The plasma sEPCR in primary glomerular disease patients is an new indicator ofcoagulation for its positive correlation with D-dimer; and the most obviously increasedlevel of plasma sEPCR in MN patients may be one of the new mechanisms inhypercoagulability and thrombosis-prone.3The sEPCR may participate in the inflammation of primary glomerular disease as itspositive correlation with IL-6and CRP; and they may play an important role in theoccurrence of inflammatory lesions and disease progression.