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目的探讨过敏性紫癜(HSP)患儿尿表皮生长因子(EGF)质量浓度检测及其对早期肾损害的诊断价值。方法91例HSP患儿为山东省青岛市妇女儿童医疗保健中心2003-01—2004-12住院确诊患儿,采用双抗体夹心ELISA方法检测HSP患儿和30例正常对照组儿童的尿EGF和尿视黄醇结合蛋白(RBP)质量浓度,同时采用全自动特殊蛋白分析仪测定尿微量白蛋白(MA)质量浓度。结果(1)HSP患儿尿EGF质量浓度[(78.59±18.09)ng/mL]明显高于正常对照组[(29.30±13.92)ng/mL],差异有显著性(t值为13.64,P<0.01)。HSP各临床分型间比较发现紫癜肾型尿EGF质量浓度[(98.31±17.68)ng/mL]分别高于其它临床型:皮肤型[(78.76±12.66)ng/mL]、腹型[(77.16±11.77)ng/mL]、关节型[(76.49±17.45)ng/mL]、混合型[(77.71±13.49)ng/mL],差异均有显著性意义(P均<0.05),而其余各临床分型间比较差异无显著性(P均>0.05)。(2)HSP患儿尿MA质量浓度为(43.21±10.23)mg/L,明显高于正常对照组[(6.41±2.86)mg/L],两者比较差异有显著性(t′=25.91,P<0.01)。(3)HSP患儿尿RBP质量浓度为(46.8±20.9)ng/mL,明显高于正常对照组[(12.8±4.8)ng/mL],差异有显著性(t′=11.98,P<0.01)。(4)91例急性期受检患儿中尿常规异常者14例(15.38%),尿MA升高者37例(61.67%),尿RBP升高者45例(75%),尿MA和(或)RBP升高者51例(85%),尿EGF升高者84例(92.3%),尿EGF阳性率与文献报道肾活检的相仿。结论HSP患儿尿EGF、RBP、MA质量浓度均明显增高,EGF在HSP伴有肾损害者早期升高尤为明显,考虑EGF增高可能与HSP病理改变程度有关,因此,EGF增高可作为HSP早期肾损害的敏感指标之一。
Objective To investigate the detection of urinary epidermal growth factor (EGF) in children with Henoch-Schonlein purpura (HSP) and its diagnostic value for early renal damage. Methods Totally 91 children with HSP were from Qingdao Children’s Medical Center of Shandong Province from January 2003 to December 2004. Urinary EGF and urine were detected by double antibody sandwich ELISA in children with HSP and in normal control group Retinol binding protein (RBP) mass concentration, while the use of automatic special protein analyzer urine microalbumin (MA) mass concentration. Results (1) The urinary EGF in children with HSP was significantly higher than that in the normal control group [(78.59 ± 18.09) ng / mL vs (29.30 ± 13.92) ng / mL, t = 13.64, P < 0.01). The clinical manifestations of HSP in purpura were found to be higher than that of other clinical types (skin type [(78.76 ± 12.66) ng / mL], abdominal type [(77.16 (77.71 ± 13.49) ng / mL], and the differences were significant (P <0.05), while the rest There was no significant difference between clinical types (all P> 0.05). (2) The urine MA concentration in HSP patients was significantly higher than that in the normal control group (43.21 ± 10.23 mg / L vs 6.41 ± 2.86 mg / L, t = 25.91, P <0.01). (3) The urinary RBP concentration in children with HSP was (46.8 ± 20.9) ng / mL, which was significantly higher than that in the normal control group [(12.8 ± 4.8) ng / mL] ). (4) Among the 91 children with acute phase, 14 (15.38%) had abnormal urine, 37 (61.67%) had elevated urine MA, 45 (75%) had elevated urine RBP, 51 cases (85%) with elevated RBP and 84 cases (92.3%) with elevated urinary EGF, the positive rate of urinary EGF was similar to that reported in the literature of renal biopsy. Conclusions The levels of urinary EGF, RBP and MA in HSP patients were significantly higher than those in normal controls, especially in the early stage of HSP with renal impairment. Considering that the increase of EGF may be related to the degree of pathological changes of HSP, EGF may be used as HSP early kidney One of the sensitive indicators of damage.