血管紧张素原在儿童过敏性紫癜肾炎发生发展中的作用

Role of angiotensinogen in progression of Henoch-Sch?nlein purpura nephritis in children

摘要:

过敏性紫癜（HSP）是儿童最常见的血管炎，约50%的HSP患儿累及肾脏，部分甚至进展为终末肾，然而其发病机制尚不明确；近年来研究发现肾内肾素- 血管紧张素系统（RAS）可能参与紫癜性肾炎（HSPN）的发病。该研究拟探讨血管紧张素原（AGT）与儿童HSP 肾损伤的相关性。方法选取30 个HSPN 患儿、31 个HSP 患儿及25 个正常对照儿童。收集治疗前患儿及对照组的血液和新鲜晨尿，检测血清尿素氮（BUN）、肌酐（SCr）、肾小球滤过率（eGFR）、尿蛋白（UP）、尿肌酐（UCr）等指标，用人AGT ELISA 试剂盒测定血清及尿液中的AGT 含量。结果HSPN 组患儿尿血管紧张素原/ 尿肌酐（UAGT/UCr）水平高于HSP 患儿及正常对照组儿童（p <0.05）；HSP患儿UAGT/UCr 水平与正常对照组儿童两组间差异无统计学意义（p >0.05）。3 组血清AGT 水平差异无统计学意义（p >0.05）。UAGT 与BUN 和血清AGT 无相关，与SCr 和UP/UCr呈正相关，与eGFR 呈负相关。结论肾内RAS 活化可能参与HSP 患儿肾脏损害的发生发展，可以通过监测UAGT 来判断疾病的严重程度，预测过敏性紫癜肾损伤的进展及预后。

Abstract:

To investigate the relationship between angiotensinogen (AGT) and renal injury in children with Henoch-Sch?nlein purpura (HSP). Methods Thirty patients with Henoch-Sch?nlein purpura nephritis (HSPN), 31 HSP patients and 25 healthy children were included in the study. Fresh morning urine and serum samples were collected before treatment in all the children. Serum concentrations of creatinine (SCr) and blood urea nitrogen (BUN), glomerular filtration rate (GFR), urine protein (UP) and urine creatinine (UCr) were measured. Serum and urine AGT levels were measured by ELISA and adjusted by urinary creatinine. Results Urinary angiotensinogen/ urine creatinine (UAGT/UCr) ratio in the HSPN children was significantly higher than that in the HSP children and the healthy controls (p < 0.05). UAGT/UCr ratio of the healthy controls was lower than that in the HSP patients but without significant difference (p > 0.05). Serum AGT levels of the three groups were not significantly different (p >0.05). UAGT was not correlated with BUN or serum AGT (p > 0.05), but positively correlated with SCr and UP/UCr(p < 0.05), and negatively correlated with GFR (p < 0.05). Conclusions Intrarenal RAS activation may be involved in the occurrence and development of renal injury in HSP children. The severity of HSP can be judged and the progression and prognosis of renal damage can be predicted by monitoring UAGT level.