過敏性紫癜性腎炎發病機制的研究進展_West China Medical Journal

Authors：

 吳秀麗 ¹ , 彭英 ¹ , 岳新愛 ¹ , 唐袁婷 ¹ , 陳平 ¹ , 玉潔 ¹ ,  張秀輝 ²

1. ;
2. ;

Corresponding?author：

張秀輝, Email: zhangxiuhui1955@126.com

Keywords：

過敏性紫癜; 腎炎; 發病機制

DOI：

10.7507/1002-0179.20140359

Video：

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過敏性紫癜性腎炎（HSPN）是一種自限性疾病，診斷依靠臨床癥狀與病理改變。治療以免疫抑制劑、血管緊張素轉換酶抑制劑、血管緊張素受體拮抗劑、激素等藥物綜合治療為主。HSPN的發生是多因素綜合作用的結果，其可能機制包括免疫反應、炎癥機制、凝血系統和基因易感性等多個方面，現圍繞HSPN的發病機制進行綜述，以期為今后能夠更好的診斷、治療HSPN提供理論基礎。

Citation： 吳秀麗, 彭英, 岳新愛, 唐袁婷, 陳平, 玉潔, 張秀輝. 過敏性紫癜性腎炎發病機制的研究進展. West China Medical Journal, 2014, 29(6): 1167-1170. doi: 10.7507/1002-0179.20140359 Copy

1.	章建娜, 呂吟秋, 許菲菲, 等. 成人與兒童紫癜性腎炎的臨床病理特點及預后分析[J]. 中國中西醫結合腎病雜志, 2009, 10(1): 33-35.
2.	Brogan PA, Dillon MJ. Vasculitis from the pediatric perspective[J]. Curr Rheumatol Rep, 2000, 2(5): 411-416.
3.	Saulsbury FT. Clinical update: Henoch-Sch?nlein purpura[J]. Lancet, 2007, 369(9566): 976-978.
4.	Soler MJ, Mir M, Rodriguez E, et al. Recurrence of IgA nephropathy and Henoch-Sch?nlein purpura after kidney transplantation: risk factors and graft survival[J]. Transplant Proc, 2005, 37(9): 3705-3709.
5.	Fervenza FC. Henoch-Sch?nlein purpura nephritis[J]. Int J Dermatol, 2003(42): 170-177.
6.	Davin JC, Ten Berge IJ, Weening JJ. What is the difference between IgA nephropathy and Henoch-Sch?nlein purpura nephritis?[J]. Kidney Int, 2001, 59(3): 823-834.
7.	Almeida JL, Campos LM, Paim LB, et al. Renal involvement in Henoch-Sch?nlein purpura: a multivariate analysis of initial prognostic factors[J]. Pediatr, 2004(83): 259-266.
8.	朱洪濤, 羅瓊, 郭艷芳. 兒童過敏性紫癜腎炎的臨床與病理相關性分析[J]. 新疆醫科大學學報, 2010, 33(6): 703-704, 707.
9.	Kiryluk K, Moldoveanu Z, Sanders JT, et al. Aberrant glycosylation of IgA1 is inherited in both pediatric IgA nephropathy and Henoch-Sch?nlein purpura nephritis[J]. Kidney Int, 2011, 80(1): 79-87.
10.	Moura IC, Arcos-Fajardo M, Sadaka C, et al. Glycosylation and size of IgA1 are essential for interaction with mesangial transferrin receptor in IgA nephropathy[J]. J Am Soc Nephrol, 2004, 15(3): 622-634.
11.	Novak J, Vu HL, Novak L, et al. Interactions of human mesangial cells with IgA and IgA-containing immune complexes[J]. Kidney Int, 2002, 62(2): 465-475.
12.	Hisano S, Matsushita M, Fujita T, et al. Activation of the lectin complement pathway in Henoch-Sch?nlein purpura nephritis[J]. Am J Kidney Dis, 2005, 45(2): 295-302.
13.	Motoyama O, Iitaka K. Henoch-Schonlein purpura with hypocomplementemia in children[J]. Pediatr Int, 2005, 47(1): 39-42.
14.	韓媛, 黃松明, 張愛華, 等. 兒童紫癜性腎炎補體C4基因多態性分析[J]. 南京醫科大學學報·自然科學版, 2010, 30(9): 1301-1305.
15.	Soto K, Wu YL, Ortiz A, et al. Familial C4B deficiency and immune complex glomerulonephritis[J]. Clin Immunol, 2010, 137(1): 166-175.
16.	Rupert KL, Moulds JM, Yang Y, et al. The molecular basis of complete complement C4A and C4B deficiencies in a systemic lupus erythematosus patient with homozygous C4A and C4B mutant genes[J]. J Immunol, 2002, 169(3): 1570-1578.
17.	Stefansson Thors V, Kolka R, Sigurdardottir SL, et al. Increased frequency of C4B^*Q0 alleles in patients with Henoch-Sch?nlein purpura[J]. Scand J Immunol, 2005, 61(3): 274-278.
18.	Bussolati B, Peri G, Salvidio G, et al. The long pentraxin PTX3 is synthesized in IgA glomerulonephritis and activates mesangial cells[J]. J Immunol, 2003, 170(3): 1466-1472.
19.	Nauta AJ, Bottazzi B, Mantovani A, et al. Biochemical and functional characterization of the interaction between pentraxin 3 and C1q[J]. Eur J Immunol, 2003, 33(2): 465-473.
20.	黃丹琳, 許自川, 黨西強, 等. 兒童紫癜性腎炎腎組織Th1/Th2比值與腎臟微血管損傷的關系[J]. 中國當代兒科雜志, 2011, 13(4): 273-277.
21.	Tsuruga K, Watanabe S, Oki E, et al. Imbalance towards Th1 pathway predominance in purpura nephritis with proteinuria[J]. Pediatr Nephrol, 2011, 26(12): 2253-2258.
22.	楊軍, 李成榮, 王國兵, 等. Th17細胞與CD4⁺ CD25⁺調節性T細胞在兒童過敏性紫癜發病機制中的作用[J]. 臨床兒科雜志, 2009, 27(7): 645-648.
23.	丁艷, 劉玲, 董宗祈. 過敏性紫癜腎炎患兒血清細胞因子水平變化及意義[J]. 臨床兒科雜志, 2005, 23(9): 643-645.
24.	潘凱麗, 白慶峰, 黃瑩, 等. 過敏性紫癜患兒血清白細胞介素-4、-6、-8及腫瘤壞死因子-α表達的意義[J]. 實用兒科臨床雜志, 2007, 22(21): 1632-1633.
25.	涂娟, 陳大坤, 曹力, 等. 過敏性紫癜患兒血小板表面黏附分子CD62P和GPⅡb/Ⅲa表達水平的變化[J]. 北京醫學, 2008, 30(11): 661-663.
26.	Kawasaki Y, Suzuki J, Nozawa R, et al. FB21, a monoclonal antibody that reacts with a sialic-acid-dependent carbohydrate epitope, is a marker for glomerular endothelial cell injury[J]. Am J Kidney Dis, 2004, 44(2): 239-249.
27.	王艷俠, 張愛平, 張穎瑋, 等. 紫癜性腎炎患者血和腎組織P選擇素的表達及意義[J]. 中華風濕病學雜志, 2003, 7(6): 343-345.
28.	崔玉霞, 劉若英, 李實光, 等. 過敏性紫癜患兒PBMC表面粘附分子表達、血清抗中性粒細胞胞漿抗體檢測情況研究[J]. 臨床兒科雜志, 2006, 24(1): 60-62.
29.	Wang LJ, Yang YH, Lin YT, et al. Levels of intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 in children with Henoch-Sch?nlein purpura[J]. J Microbiol Immunol Infect, 2006, 39(2): 109-113.
30.	Gluhovschi C, Gluhovschi G, Potencz E, et al. The endothelial cell markers von Willebrand Factor (vWF), CD31 and CD34 are lost in glomerulonephritis and no longer correlate with the morphological indices of glomerular sclerosis, interstitial fibrosis, activity and chronicity[J]. Folia Histochem Cytobiol, 2010, 48(2): 230-236.
31.	張洪霞, 劉雪梅, 柳方娥, 等. 過敏性紫癜患兒GPⅡb/Ⅲa、P-選擇素及vWF檢測的意義[J]. 山東大學學報·醫學版, 2009, 47(1): 64-67.
32.	張愛娥, 云鷹. 過敏性紫癜腎炎凝血機制研究[J]. 醫學綜述, 2005, 11(2): 173-175.
33.	Ozkaya O, S?ylemezo?lu O, G?nen S, et al. Renin-angiotensin system gene polymorphisms: association with susceptibility to Henoch-Schonlein purpura and renal involvement[J]. Clin Rheumatol, 2006, 25(6): 861-865.
34.	崔張莉, 石巖, 陰懷清, 等. 血管緊張素轉換酶基因多態性與小兒過敏性紫癜及紫癜性腎炎的關聯性[J]. 中國當代醫藥, 2010, 17(13): 5-8.
35.	Amoli MM, Thomson W, Hajeer AH, et al. HLA-B35 association with nephritis in Henoch-Sch?nlein purpura[J]. J Rheumatol, 2002, 29(5): 948-949.
36.	任少敏, 錫林高娃,仝林虎, 等.內蒙地區漢族兒童HLA-DQAI基因與紫癜性腎炎的遺傳易感性[J]. 中華腎臟病雜志, 2001, 17(4): 259.
37.	張洪霞. 小兒紫癜性腎炎的發病機制研究進展[J]. 中華現代兒科學雜志, 2008, 5(2): 126-129.
38.	Syrj?nen J, Hurme M, Lehtim?ki T, et al. Polymorphism of the cytokine genes and IgA nephropathy[J]. Kidney Int, 2002, 61(3): 1079-1085.
39.	Shu KH, Lee SH, Cheng CH, et al. Impact of interleukin-1 receptor antagonist and tumor necrosis factor-alpha gene polymorphism on IgA nephropathy[J]. Kidney Int, 2000, 58(2): 783-789.

1. 章建娜, 呂吟秋, 許菲菲, 等. 成人與兒童紫癜性腎炎的臨床病理特點及預后分析[J]. 中國中西醫結合腎病雜志, 2009, 10(1): 33-35.
2. Brogan PA, Dillon MJ. Vasculitis from the pediatric perspective[J]. Curr Rheumatol Rep, 2000, 2(5): 411-416.
3. Saulsbury FT. Clinical update: Henoch-Sch?nlein purpura[J]. Lancet, 2007, 369(9566): 976-978.
4. Soler MJ, Mir M, Rodriguez E, et al. Recurrence of IgA nephropathy and Henoch-Sch?nlein purpura after kidney transplantation: risk factors and graft survival[J]. Transplant Proc, 2005, 37(9): 3705-3709.
5. Fervenza FC. Henoch-Sch?nlein purpura nephritis[J]. Int J Dermatol, 2003(42): 170-177.
6. Davin JC, Ten Berge IJ, Weening JJ. What is the difference between IgA nephropathy and Henoch-Sch?nlein purpura nephritis?[J]. Kidney Int, 2001, 59(3): 823-834.
7. Almeida JL, Campos LM, Paim LB, et al. Renal involvement in Henoch-Sch?nlein purpura: a multivariate analysis of initial prognostic factors[J]. Pediatr, 2004(83): 259-266.
8. 朱洪濤, 羅瓊, 郭艷芳. 兒童過敏性紫癜腎炎的臨床與病理相關性分析[J]. 新疆醫科大學學報, 2010, 33(6): 703-704, 707.
9. Kiryluk K, Moldoveanu Z, Sanders JT, et al. Aberrant glycosylation of IgA1 is inherited in both pediatric IgA nephropathy and Henoch-Sch?nlein purpura nephritis[J]. Kidney Int, 2011, 80(1): 79-87.
10. Moura IC, Arcos-Fajardo M, Sadaka C, et al. Glycosylation and size of IgA1 are essential for interaction with mesangial transferrin receptor in IgA nephropathy[J]. J Am Soc Nephrol, 2004, 15(3): 622-634.
11. Novak J, Vu HL, Novak L, et al. Interactions of human mesangial cells with IgA and IgA-containing immune complexes[J]. Kidney Int, 2002, 62(2): 465-475.
12. Hisano S, Matsushita M, Fujita T, et al. Activation of the lectin complement pathway in Henoch-Sch?nlein purpura nephritis[J]. Am J Kidney Dis, 2005, 45(2): 295-302.
13. Motoyama O, Iitaka K. Henoch-Schonlein purpura with hypocomplementemia in children[J]. Pediatr Int, 2005, 47(1): 39-42.
14. 韓媛, 黃松明, 張愛華, 等. 兒童紫癜性腎炎補體C4基因多態性分析[J]. 南京醫科大學學報·自然科學版, 2010, 30(9): 1301-1305.
15. Soto K, Wu YL, Ortiz A, et al. Familial C4B deficiency and immune complex glomerulonephritis[J]. Clin Immunol, 2010, 137(1): 166-175.
16. Rupert KL, Moulds JM, Yang Y, et al. The molecular basis of complete complement C4A and C4B deficiencies in a systemic lupus erythematosus patient with homozygous C4A and C4B mutant genes[J]. J Immunol, 2002, 169(3): 1570-1578.
17. Stefansson Thors V, Kolka R, Sigurdardottir SL, et al. Increased frequency of C4B^*Q0 alleles in patients with Henoch-Sch?nlein purpura[J]. Scand J Immunol, 2005, 61(3): 274-278.
18. Bussolati B, Peri G, Salvidio G, et al. The long pentraxin PTX3 is synthesized in IgA glomerulonephritis and activates mesangial cells[J]. J Immunol, 2003, 170(3): 1466-1472.
19. Nauta AJ, Bottazzi B, Mantovani A, et al. Biochemical and functional characterization of the interaction between pentraxin 3 and C1q[J]. Eur J Immunol, 2003, 33(2): 465-473.
20. 黃丹琳, 許自川, 黨西強, 等. 兒童紫癜性腎炎腎組織Th1/Th2比值與腎臟微血管損傷的關系[J]. 中國當代兒科雜志, 2011, 13(4): 273-277.
21. Tsuruga K, Watanabe S, Oki E, et al. Imbalance towards Th1 pathway predominance in purpura nephritis with proteinuria[J]. Pediatr Nephrol, 2011, 26(12): 2253-2258.
22. 楊軍, 李成榮, 王國兵, 等. Th17細胞與CD4⁺ CD25⁺調節性T細胞在兒童過敏性紫癜發病機制中的作用[J]. 臨床兒科雜志, 2009, 27(7): 645-648.
23. 丁艷, 劉玲, 董宗祈. 過敏性紫癜腎炎患兒血清細胞因子水平變化及意義[J]. 臨床兒科雜志, 2005, 23(9): 643-645.
24. 潘凱麗, 白慶峰, 黃瑩, 等. 過敏性紫癜患兒血清白細胞介素-4、-6、-8及腫瘤壞死因子-α表達的意義[J]. 實用兒科臨床雜志, 2007, 22(21): 1632-1633.
25. 涂娟, 陳大坤, 曹力, 等. 過敏性紫癜患兒血小板表面黏附分子CD62P和GPⅡb/Ⅲa表達水平的變化[J]. 北京醫學, 2008, 30(11): 661-663.
26. Kawasaki Y, Suzuki J, Nozawa R, et al. FB21, a monoclonal antibody that reacts with a sialic-acid-dependent carbohydrate epitope, is a marker for glomerular endothelial cell injury[J]. Am J Kidney Dis, 2004, 44(2): 239-249.
27. 王艷俠, 張愛平, 張穎瑋, 等. 紫癜性腎炎患者血和腎組織P選擇素的表達及意義[J]. 中華風濕病學雜志, 2003, 7(6): 343-345.
28. 崔玉霞, 劉若英, 李實光, 等. 過敏性紫癜患兒PBMC表面粘附分子表達、血清抗中性粒細胞胞漿抗體檢測情況研究[J]. 臨床兒科雜志, 2006, 24(1): 60-62.
29. Wang LJ, Yang YH, Lin YT, et al. Levels of intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 in children with Henoch-Sch?nlein purpura[J]. J Microbiol Immunol Infect, 2006, 39(2): 109-113.
30. Gluhovschi C, Gluhovschi G, Potencz E, et al. The endothelial cell markers von Willebrand Factor (vWF), CD31 and CD34 are lost in glomerulonephritis and no longer correlate with the morphological indices of glomerular sclerosis, interstitial fibrosis, activity and chronicity[J]. Folia Histochem Cytobiol, 2010, 48(2): 230-236.
31. 張洪霞, 劉雪梅, 柳方娥, 等. 過敏性紫癜患兒GPⅡb/Ⅲa、P-選擇素及vWF檢測的意義[J]. 山東大學學報·醫學版, 2009, 47(1): 64-67.
32. 張愛娥, 云鷹. 過敏性紫癜腎炎凝血機制研究[J]. 醫學綜述, 2005, 11(2): 173-175.
33. Ozkaya O, S?ylemezo?lu O, G?nen S, et al. Renin-angiotensin system gene polymorphisms: association with susceptibility to Henoch-Schonlein purpura and renal involvement[J]. Clin Rheumatol, 2006, 25(6): 861-865.
34. 崔張莉, 石巖, 陰懷清, 等. 血管緊張素轉換酶基因多態性與小兒過敏性紫癜及紫癜性腎炎的關聯性[J]. 中國當代醫藥, 2010, 17(13): 5-8.
35. Amoli MM, Thomson W, Hajeer AH, et al. HLA-B35 association with nephritis in Henoch-Sch?nlein purpura[J]. J Rheumatol, 2002, 29(5): 948-949.
36. 任少敏, 錫林高娃,仝林虎, 等.內蒙地區漢族兒童HLA-DQAI基因與紫癜性腎炎的遺傳易感性[J]. 中華腎臟病雜志, 2001, 17(4): 259.
37. 張洪霞. 小兒紫癜性腎炎的發病機制研究進展[J]. 中華現代兒科學雜志, 2008, 5(2): 126-129.
38. Syrj?nen J, Hurme M, Lehtim?ki T, et al. Polymorphism of the cytokine genes and IgA nephropathy[J]. Kidney Int, 2002, 61(3): 1079-1085.
39. Shu KH, Lee SH, Cheng CH, et al. Impact of interleukin-1 receptor antagonist and tumor necrosis factor-alpha gene polymorphism on IgA nephropathy[J]. Kidney Int, 2000, 58(2): 783-789.

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過敏性紫癜性腎炎發病機制的研究進展

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