血清和尿液基质金属蛋白酶-9水平在早期检测过敏性紫癜患儿肾脏受累中的潜力
Potential of Serum and Urinary Matrix Metalloproteinase-9 Levels for the Early Detection of Renal Involvement in Children With Henoch-Schönlein Purpura.
作者信息
Erol Meltem, Yigit Ozgul, Tasdemir Mehmet, Bostan Gayret Ozlem, Buke Ovgu, Gunes Aysegul, Hamilcikan Sahin, Kasapcopur Ozgur
机构信息
Department of Pediatrics, Bagcilar Training and Research Hospital, Istanbul, Turkey.
Department of Pediatric Nephology, Koc University Hospital, Istanbul, Turkey.
出版信息
Iran J Pediatr. 2016 Jun 5;26(4):e6129. doi: 10.5812/ijp.6129. eCollection 2016 Aug.
BACKGROUND
Matrix metalloproteinase-9 (MMP-9) is an enzyme implicated in the pathogenesis of renal diseases. Renal involvement is the principal cause of morbidity and mortality in children with Henoch-Schönlein purpura (HSP).
OBJECTIVES
The aim of this study was to evaluate whether serum and urinary MMP-9 levels are associated with renal involvement in HSP.
PATIENTS AND METHODS
We evaluated 40 children with HSP (patient group) and 27 healthy volunteer children (control group). The patient group was divided into two subgroups based on the presence or absence of nephritis. Nephritis was defined as the existence of hematuria and/or proteinuria. All anthropometric data, physical examination findings, blood pressure, and laboratory parameters were recorded. The serum and urine samples were analyzed to determine the MMP-9 levels three days after the initial phase of the disease.
RESULTS
The mean age was 7.65 ± 3.41 (range 2 - 16) years in the patient group and 9.52 ± 3.91 (range 2 - 16) years in the control group. Henoch-Schonlein purpura nephritis (HSPN) was identified in eight patients. There was no significant difference in the serum MMP-9 levels between the HSPN subgroup and the controls (P > 0.05). However, there were significant differences in the urinary MMP-9 levels between the HSP subgroup and the control group (P < 0.05), with the urinary MMP-9 levels being significantly higher in patients in the HSP subgroup (P = 0.001). Further, the urinary MMP-9 levels were significantly higher in the patients with nephritis than in the patients without nephritis (P = 0.001) and the controls (P = 0.001). The optimal cut-off point (sensitivity; specificity) of the urinary MMP-9 level for the diagnosis of HSPN was 94.7 pg/mL.
CONCLUSIONS
The levels of MMP-9 in the urine were remarkably high in patients with HSPN. This non-invasive marker may therefore be an important indicator for the early diagnosis of nephritis in children with HSP.
背景
基质金属蛋白酶-9（MMP-9）是一种与肾脏疾病发病机制相关的酶。肾脏受累是过敏性紫癜（HSP）患儿发病和死亡的主要原因。
目的
本研究旨在评估血清和尿液MMP-9水平是否与HSP患儿的肾脏受累有关。
患者与方法
我们评估了40例HSP患儿（患者组）和27例健康志愿者儿童（对照组）。根据是否存在肾炎，将患者组分为两个亚组。肾炎定义为存在血尿和/或蛋白尿。记录所有人体测量数据、体格检查结果、血压和实验室参数。在疾病初始阶段三天后，分析血清和尿液样本以测定MMP-9水平。
结果
患者组的平均年龄为7.65±3.41（范围2 - 16）岁，对照组为9.52±3.91（范围2 - 16）岁。8例患者被诊断为过敏性紫癜肾炎（HSPN）。HSPN亚组与对照组之间的血清MMP-9水平无显著差异（P>0.05）。然而，HSP亚组与对照组之间的尿液MMP-9水平存在显著差异（P<0.05），HSP亚组患者的尿液MMP-9水平显著更高（P = 0.001）。此外，肾炎患者的尿液MMP-9水平显著高于无肾炎患者（P = 0.001）和对照组（P = 0.001）。尿液MMP-9水平诊断HSPN的最佳截断点（敏感性；特异性）为94.7 pg/mL。
结论
HSPN患者尿液中的MMP-9水平显著升高。因此，这种非侵入性标志物可能是HSP患儿肾炎早期诊断的重要指标。
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