The Variation And Significance Of Serum Interleukin-17and Matrixmetalloproteinase-9of Childdren In Acute Phase Of Henoch-schonlein Purpura

Objective: Henoch-Schonlein purpura is the most common kind ofimmune mediated systemic vasculitis in childhood, whether to merge kidneyinvolvement，that directly affect the long-term prognosis of Henoch-Schonleinpurpura, its pathogenesis is still not clear, so there is also no effective defensemeasures to prevent HSP emerging kidney involvemengt. A large number ofstudies has shown that pathogenesis of HSP and HSPN is mainly for thehumoral and cellular immune abnormalities, blood coagulation andfibrinolytic disorders, change of gene polymorphism, participation ofinflammation medium, and cytokines aslo play an important role. IL-17is anewly found kind of proinflammatory cytokines, plays an important role in avariety of immune vasculitis, whether its antagonist can applly to the clinicaltreatment of autoimmune diseases has become a research hot spot. AsHenoch-Schonlein purpura is aslo a kind of autoimmune vasculitis, this studyfurther investigate the level variation of serum IL-17and matrixmetalloproteinases-nine (MMP-9) in childhood in acute phase ofHenoch-Schonlein purpura, and observe whether they have correlation, andHenoch-Schonlein purpura childhood are followed up for6months, to observewhether the kidney is affected, and then we can have a deeper understandingof the IL-17and MMP-9in the pathogenesis of HSP/HSPN. Providingtheoretical basis for how to adopt active treatment and take interventionmeasures to prevent HSP emerging kidney involvemengt.Methods:1.The research object Senventy four cases of hospitalized children inacute phase of Henoch-Schonlein purpura from March2012to July2012inHebei Province Children’s Hospital in Nephroloy and Immunology departmant are included in this study. Among them,38are male and36are female, aged3to12years old.The clinical diagnosis of HSP is based on the criteria definedby the "ZhuFuTang practical pediatrics"; The clinical diagnosis of HSPN isbased on the criteria defined by the Chinese medical association branch ofkidney disease of Pediatrics,in the course of Henoch-Schonlein purpura (mostin6months),the occurrence of renal parenchyma involvement (hematuriaand/or proteinuria), and excluding other kidney disease which can causehematuria and proteinuria.2. Experimental group：(1)Henoch-Schonlein purpura group: Childhoodsin acute phase of Henoch-Schonlein purpura (according the diagnosticcriteria of Zhu Fu Tang Practical Pediatrics in HSP):adrenal corticosteroidsand immunosuppressants treatment are notused within one week, and excludeprevious autoimmune diseases or allergic disease history; based on the clinicalmanifestations, they are divided into simple type，joints, abdominal and mixedtype.(2) Non-HSPN group and HSPN group: closing follow-up the includedgroup of children6months, depending on whether the kidney was involved,they were devided into non-HSPN group and HSPN group.(3) Control group:Recruited same period of30healthy children who are examinated in Ourhospital of Child Health Division, age-and sex-matched, and excludedprevious autoimmune disease and allergic disease history.3.Detection indicators and experimental methods：The serum of IL-17and MMP-9levels are detected by Enzyme-linked immunosorbentassay(ELISA), also analyze the correlation of IL-17and MMP-9.Thedetection indicators are serum specimens of children with acute HSP. SPSS13.0software is used for statistical analysis, the levels were expressed asmean±s.e.m. The comparisons between groups used the T test,one-wayANOVA and Mann-Whitney. And the trend variables were using linearcorrelation analysis. A two-tailed P value of<0.05was considered significantdifference, or considered no significant difference.Results:1.The concentration serum IL-17is significantly higher in childhood in acute phase of Henoch-Schonlein purpura than in healthy control group(86.59±35.50vs.62.38±14.65) pg mL-1,P <0.01).2. The concentration serum MMP-9is significantly higher in childhoodin acute phase of Henoch-Schonlein purpura than in healthy control group(201.82±105.87vs.89.27±27.99) ng mL-1,P <0.01).3. The serum IL-17levels between the various types ofHenoch-Schonlein purpura in acute phase is no significant difference (P>0.05).4. The serum MMP-9level between the various types ofHenoch-Schonlein purpura in acute phase display: Mixed type was higherthan simple、 joints、abdominal (P <0.05), while between simple type、joints and abdominal the MMP-9level shows no difference.5. In acute phase of HSP,the serum IL-17level is significantly higher inHSPN group than non-HSPN group (101.67±39.55vs81.38±32.79) pg mL-1,P<0.05).6．The serum MMP-9level is significantly higher in HSPN group thannon-HSPN group (249.63±97.57vs185.30±104.39ng.mL-1,P <0.05),atthe acute phase of HSP.7.The correlation analysis of serum IL-17and MMP-9in childhood inacute phase of Henoch-Schonlein purpura display（r=0.184, P>0.05),whichexlpains that there is no correlation between IL-17and MMP-9.Conclusion:The data in this study demonstrates that IL-17and MMP-9are involved in the pathogenesis of HSP in the acute phase,and these twovalues are higher in HSPN group than non-HSPN group,which indicates thatIL-17, MMP-9have played a role in the acute phase of HSP, that promptes usto get early takes to prevent the HSP emerging kidney involvemengt.The serum IL-17level in different clinical forms of childhood in acute phaseof HSP shows no significant difference,which indicates that the inflammatoryresponse of IL-17participation in the different clinical forms of HSP arenot different.We found serum MMP-9levels in mixed group is higher thansimple, joints, abdominal types (P <0.05), simple type,abdominal and joints types showed no differences, which explains that the vascular injury of mixedtype is more serious,and more likely to merge kidney involvemengt; while theIL-17and MMP-9correlation analysis found that they do not have acorrelation (r=0.184, P>0.05).