| Objective: Allergic purpura, also known as Heng-shu syndrome(Henoch-Schonlein purpura HSP), is the most common micro vascular allergic hemorrhagic disease in childhood.The pathological changes are abnormal immune mechanism caused multiple factors, immune complexes based on Ig A are widely deposited in vascular wall of multiple organs, resulting in increased vascular permeability, exudation of blood and lymph fluid, skin mucous membrane, kidney, brain, joint multiple sites lesions. The clinical manifestations include non thrombocytopenic touch skin purpura, with or without abdominal pain, hematochezia, joint swelling and pain etc. Relating to the merger of kidney damage, can appear albuminuria, hematuria, called purpura nephritis(Henoeh-Schonlein purpura nephritis, HSPN), is the main reason to affect the prognosis of the disease. Its pathogenesis is not clear at present, relates to the humoral immune abnormality, cellular immune abnormality, while there are other factors involved in such as environmental factors, genetic susceptibility, various cytokines, inflammatory mediatorsi. Lipoxin A4(LXA4)is a kind of four arachidonic acid metabolites. Research has shown that, as an endogenous lipid mediators, LXA4 has clear effects of anti-inflammatory and mediating various inflammation regression, called “braking signals”of inflammatory reaction. IL-22 is a pro-inflammatory cytokine recently discovered, plays an important role in the pathogenesis of various inflammatory diseases and autoimmune diseases.Allergic purpura is a kind of autoimmune vasculitis disease, this study further investigates that the level variation of serum LXA4 and IL-22 in acute group and remission group in children of HSP, compared with the healthy control group, to observe the expression of each index in different stages. And they are followed up for 6 months, to observe whether the kidney is affected. Compared the difference of serum LXA4 and IL-22 concentration level in acute group and remission group between non-HSPN group and HSP group, then we can have a deeper understanding of LXA4 and IL-22 in the pathogenesis of HSP/HSPN, so as to provide a theoretical basis for how to treat primary disease actively and take intervention measures to prevent the emergence of HSPN.Methods:1 The research object Sixty-six cases of hospitalized children with newly diagnosed of Henoch-Schonlein purpura in Nephroloy and Immunology departmant of Hebei Province Children’s Hospital from April 2014 to August 2014 were included in this study. Among them,28 were male and 36 were female, aged 3 to 13 years old. The basis of clinical diagnosis criteria of HSP:typical skin rash, with or without gastrointestinal tract, joints, kidneys symptoms and blood platelet count not less. The clinical diagnosis criteria of HSPN: in the course of Henoch-Schonlein purpura(most in 6 months), the occurrence of renal parenchyma involvement(hematuria and/or proteinuria), and excluding other kidney disease which can cause hematuria and proteinuria.2 Experimental group(1)Henoch-Schonlein purpura in acute group: the first onset, unused antihistamines, adrenal cortical hormone and immunosuppressive therapy within one week, and exclude previous autoimmune diseases or allergic disease history.(2)Henoch-Schonlein purpura in remission group: collecting fasting blood 3 days after the disappearance of the rash, abdominal pain, joint swelling and pain as specimens of the early remission.(3)Control group: Recruited same period of 30 healthy children who were examinated in Child Health Division of our hospital age 3-14 years old, male 13 cases, female 17 cases, mean age 6.6±2.4 years, and excluded previous autoimmune disease and allergic disease history.(4) Non-HSPN group and HSPN group: closing follow-up the included group of children 6 months, depending on whether the kidney was involved, they were devided into non-HSPN group and HSPN group.3 Detection indicators and experimental methods:The serum of lipoxin A4 and IL-22 levels were detected by Enzyme-linked immunosorbent assay(ELISA), operation procedures strictly accord to kit instructions. The detection samples were serum specimens of HSP children in acute group and remission group. SPSS 13.0 software was used for statistical analysis, the levels were expressed as mean±s.e.m. The comparisons between groups used the T test, one-way ANOVA and Man n-Whitney. A two-tailed P value of<0.05 was considered significant difference, or considered no significant difference.Results:1 The serum LXA4 in children with Henoch Schonlein purpura in acute group and remission group were significantly higher than that in control group[(67.77±17.85)vs(53.2±121.94)nmol/L,(128.42±29.61)vs(53.2±121.94) nmol/L], the differences were statistically significant(P <0.01).2 The serum LXA4 level was significantly lower in acute group than in remission group in children with Henoch Schonlein purpura [(67.77 ±17.85) vs(128.42±29.61) nmol/L],the difference was statistically significant(P<0.01).3 The serum LXA4 level in acute goup was significantly higher in non-HSPN group than HSPN group [(72.04±18.20)vs(57.96±12.65) nmol/L], the difference was statistically significant(P< 0.01).4 The serum LXA4 level in remission group was significantly higher in non-HSPN group than HSPN group[(134.25±31.81)vs(115.02± 18.21) nmol/L],the difference was statistically significant(P< 0.01).5 The serum IL-22 level in children with Henoch Schonlein purpura in acute group and remission group were significantly higher than that in control group[(34.26±17.20)vs(15.67±7.74)pg/ml,[(36.17±18.27)vs(15.67±7.74) pg/ml],the differences were statistically significant(P< 0.01).6 The serum IL-22 level in children with Henoch Schonlein purpura shows no significant difference between acute group and remission group [(34.26±17.20) vs(36.17±18.27)pg/ml](P>0.05).7 The serum IL-22 level in acute group in children with Henoch Schonlein purpura shows no significant difference between non-HSPN group and HSP group[(33.59 ±18.00) vs(35.81 ± 15.54)pg/ml](P>0.01).8 The serum IL-22 level in remission group was significantly lower in non-HSPN group than HSPN group[(31.18±14.40)vs(47.64±21.24) pg/ml], the difference was statistically significant(P< 0.01).Conclusion:The data in this study demonstrates that LXA4 as an anti-inflammatory cytokine, guide the regressive effects of inflammation during the course of Henoch Schonlein purpura. The serum LXA4 level is significantly lower in HSPN group than non-HSPN group in children with Henoch Schonlein purpura in acute group and remission group.The synthesis deficiency of LXA4 is closely related with the occurrence of HSPN, influencing the prognosis of the disease.IL-22 as an inflammatory factor, mediates the pathogenesis of Henoch Schonlein purpura, but this study shows that the serum IL-22 levels has no significant difference between acute group and remission group.The increase of IL-22 content may be more prone to renal involvement, influencing the development and prognosis of HSPN. |
PDF Full Text Request