| Background Hemophagocytic syndrome(HPS),is an macrophage proliferative disease that multi-organ and multi-system were involved,and progressive increase with immune dysfunction.Clinical manifestation are diverse,the disease proceeds extremely fast with extremely high death rate if not treated timely.It can be divided to primary HPS and secondary HPS based on the cause of disease.As the disease cause and pathogenesis of the secondary HPS are quite complicated,its molecular biological mechanism has not been fully illustrated and the diagnosis mainly based on the nonspecific clinical index.As a result,it is very necessary to deeply study HPS pathogenesis and find out laboratory index with clinical meanings for further directing treatment.CD163 is a kind of transmembrane glycoprotein which is found out as only expressing on monocyte/macrophage membrane recently and sCD163 is its soluble form which can be the serological markers of the monocyte/macrophage.The study shows that sCD163 can activate signal transduction pathway within the monocyte/macrophage so as to up-regulate cytokine expression such as TNF-a?IL-10 and Heme oxygenase 1 to play the role as antiinflammatory and antioxidant.There are studies validating that CD163 can clear free hemoglobin(Hb)through CD163/HO-1 pathway to reduce its toxic on the body and directly plays a role of antiinflammatory and antioxidant.In recent years,studies on CD163/HO-1 is more and more.Some studies found that CD163/HO-1 has engaged in the pathogenic process of various diseases such as acute lung injury,rheumatoid arthritis,malignant tumor and acute liver failure.Studies show that the expression of sCD163 in many diseases such as autoimmune disease,infections,and tumor.Meanwhile,scholars found that the expression of HO-1 in HPS is obviously higher than other hematological diseases.Objective By detecting serum sCD163 and HO-1 levels in the peripheral blood in HPS,this study was to investigate the correlation between sCD163 and HO-1 levels.Investigate the role of sCD163 and HO-1 in the pathogenesis of HPS,and relevance of clinical manifestations of HPS.And compare the variety before and after the treatment,that will provide a new theory basis for the pathogenesis and curative effect evaluation of HPS.Methods Selecting 56 patients with HPS who were enrolled in the pediatric ward and outpatient department of the First Affiliated Hospital of Zhengzhou University from December 2014 to 2016 November were HPS group,40 normal pneumonia were common infection group,and 35 children who received physical examination in our hospital in the same time were normal control group.All children clinical data is complete,parents or guardians are informed consent.Children of normal control group and common infection group were taken 4ml peripheral venous blood at the initial visit,children of HPS group were taken 4ml peripheral venous blood before treatment,after treatment for two weeks,four weeks and eight weeks.All samples were placed in EDTA anticoagulant tube and allowed to stand at room temperature for one hour,and then centrifuged at 3400 r / min for 8 min.the supernatant was placed in the refrigerator at-80?.(1)Detecting serum sCD163 and HO-1 levels in the peripheral blood in HPS group by ELISA,comparing the differences of sCD163 and HO-1 among the three groups before treatment,analyzing the correlation between sCD163 and HO-1 levels;Comparing differences of serum sCD163 and HO-1 levels among different suffering cause;comparing trends of serum sCD163 and HO-1 levels at different time points before and after treatment.(2)Collecting clinical and laboratory data in HPS group,then analyzing the correlation and relevance between clinical and laboratory data with serum sCD163 and HO-1 levels.Results1.Comparison of serum sCD163 and HO-1 among the three groups: Compared with the normal control group,the levels of serum sCD163 in HPS group and common infection group were increased in varying degrees,the difference was statistically significant(F=138.698,P<0.05),The differences between any two groups were statistically significant(P<0.05);normal control group,common infection group and HPS group,the levels of serum HO-1 were statistically significant(F=318.193,P<0.05),The difference between any two groups was statistically significant(P<0.05).And the serum sCD163 and HO-1 were positively correlated with the correlation coefficient r = 0.839(P<0.05).2.Comparison of sCD163 and HO-1 in secondary HPS caused by different causes :The serum levels of sCD163 and HO-1 in different etiology groups were statistically significant(x2=16.699,P<0.05;x2=18.499,P<0.05),Pairwise comparison showed that MAHS group,serum sCD163 and HO-1 level were significantly higher than those in IAHS group and AAHS group(P<0.05),however,the difference between AAHS group and IAHS group,the sCD163 level was no statistically significant(P>0.05),the serum HO-1 level in AAHS group was also significantly higher than IAHS group(P<0.05).3.Comparison of sCD163 and HO-1 levels in HPS group at different time points before and after treatment: the levels of sCD163 and HO-1 were significantly decreased with the prolongation of treatment time and the improvement of condition, The difference was statistically significant(F= 58.293,P<0.05;F=95.682,P<0.05),And the difference between two adjacent time points was statistically significant(P<0.05).4.Correlation analysis of sCD163 and HO-1 levels with clinical and laboratory parameters in HPS group: the serum sCD163 level in HPS group and HO-1,serum ferritin,C reactive protein and procalcitonin were positively correlated(P<0.05);and negatively correlated with neutrophil count,hemoglobin,platelet count(P<0.05);whereas serum sCD163 levels and other indicators were no significantly correlated(P>0.05);Similarly,the serum HO-1 levels were positively correlated with sCD163,serum ferritin,C reactive protein and procalcitonin(P<0.05);and negatively correlated with hemoglobin(P<0.05);and serum HO-1 and other clinical and laboratory parameters were not significantly correlated(P>0.05).Conclusions1.Serum sCD163 and HO-1 were involved in the pathogenesis of secondary HPS,for children with suspected HPS,early detection of serum sCD163 and HO-1will provide a basis for further diagnosis.2.The level of serum sCD163 and HO-1 may provide some clues for the identification of MAHS and other causes of hemophagocytosis;3.The level of serum sCD163 and HO-1 can be used as an important indicator to monitor the condition of secondary HPS and guide the treatment. |
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