过敏性紫癜性肾炎发病机制的研究进展_West China Medical Journal

Authors：

 吴秀丽 ¹ , 彭英 ¹ , 岳新爱 ¹ , 唐袁婷 ¹ , 陈平 ¹ , 玉洁 ¹ ,  张秀辉 ²

1. ;
2. ;

Corresponding author：

张秀辉, Email: zhangxiuhui1955@126.com

Keywords：

过敏性紫癜; 肾炎; 发病机制

DOI：

10.7507/1002-0179.20140359

Video：

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过敏性紫癜性肾炎（HSPN）是一种自限性疾病，诊断依靠临床症状与病理改变。治疗以免疫抑制剂、血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、激素等药物综合治疗为主。HSPN的发生是多因素综合作用的结果，其可能机制包括免疫反应、炎症机制、凝血系统和基因易感性等多个方面，现围绕HSPN的发病机制进行综述，以期为今后能够更好的诊断、治疗HSPN提供理论基础。

Citation： 吴秀丽, 彭英, 岳新爱, 唐袁婷, 陈平, 玉洁, 张秀辉. 过敏性紫癜性肾炎发病机制的研究进展. West China Medical Journal, 2014, 29(6): 1167-1170. doi: 10.7507/1002-0179.20140359 Copy

1.	章建娜, 吕吟秋, 许菲菲, 等. 成人与儿童紫癜性肾炎的临床病理特点及预后分析[J]. 中国中西医结合肾病杂志, 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-Schönlein purpura[J]. Lancet, 2007, 369(9566): 976-978.
4.	Soler MJ, Mir M, Rodriguez E, et al. Recurrence of IgA nephropathy and Henoch-Schönlein purpura after kidney transplantation: risk factors and graft survival[J]. Transplant Proc, 2005, 37(9): 3705-3709.
5.	Fervenza FC. Henoch-Schönlein 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-Schönlein purpura nephritis?[J]. Kidney Int, 2001, 59(3): 823-834.
7.	Almeida JL, Campos LM, Paim LB, et al. Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors[J]. Pediatr, 2004(83): 259-266.
8.	朱洪涛, 罗琼, 郭艳芳. 儿童过敏性紫癜肾炎的临床与病理相关性分析[J]. 新疆医科大学学报, 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-Schönlein 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-Schönlein 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.	韩媛, 黄松明, 张爱华, 等. 儿童紫癜性肾炎补体C4基因多态性分析[J]. 南京医科大学学报·自然科学版, 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-Schönlein 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.	黄丹琳, 许自川, 党西强, 等. 儿童紫癜性肾炎肾组织Th1/Th2比值与肾脏微血管损伤的关系[J]. 中国当代儿科杂志, 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.	杨军, 李成荣, 王国兵, 等. Th17细胞与CD4⁺ CD25⁺调节性T细胞在儿童过敏性紫癜发病机制中的作用[J]. 临床儿科杂志, 2009, 27(7): 645-648.
23.	丁艳, 刘玲, 董宗祈. 过敏性紫癜肾炎患儿血清细胞因子水平变化及意义[J]. 临床儿科杂志, 2005, 23(9): 643-645.
24.	潘凯丽, 白庆峰, 黄莹, 等. 过敏性紫癜患儿血清白细胞介素-4、-6、-8及肿瘤坏死因子-α表达的意义[J]. 实用儿科临床杂志, 2007, 22(21): 1632-1633.
25.	涂娟, 陈大坤, 曹力, 等. 过敏性紫癜患儿血小板表面黏附分子CD62P和GPⅡb/Ⅲa表达水平的变化[J]. 北京医学, 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.	王艳侠, 张爱平, 张颖玮, 等. 紫癜性肾炎患者血和肾组织P选择素的表达及意义[J]. 中华风湿病学杂志, 2003, 7(6): 343-345.
28.	崔玉霞, 刘若英, 李实光, 等. 过敏性紫癜患儿PBMC表面粘附分子表达、血清抗中性粒细胞胞浆抗体检测情况研究[J]. 临床儿科杂志, 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-Schönlein 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.	张洪霞, 刘雪梅, 柳方娥, 等. 过敏性紫癜患儿GPⅡb/Ⅲa、P-选择素及vWF检测的意义[J]. 山东大学学报·医学版, 2009, 47(1): 64-67.
32.	张爱娥, 云鹰. 过敏性紫癜肾炎凝血机制研究[J]. 医学综述, 2005, 11(2): 173-175.
33.	Ozkaya O, Söylemezoğlu O, Gönen 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.	崔张莉, 石岩, 阴怀清, 等. 血管紧张素转换酶基因多态性与小儿过敏性紫癜及紫癜性肾炎的关联性[J]. 中国当代医药, 2010, 17(13): 5-8.
35.	Amoli MM, Thomson W, Hajeer AH, et al. HLA-B35 association with nephritis in Henoch-Schönlein purpura[J]. J Rheumatol, 2002, 29(5): 948-949.
36.	任少敏, 锡林高娃,仝林虎, 等.内蒙地区汉族儿童HLA-DQAI基因与紫癜性肾炎的遗传易感性[J]. 中华肾脏病杂志, 2001, 17(4): 259.
37.	张洪霞. 小儿紫癜性肾炎的发病机制研究进展[J]. 中华现代儿科学杂志, 2008, 5(2): 126-129.
38.	Syrjänen J, Hurme M, Lehtimäki 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, 吕吟秋, 许菲菲, 等. 成人与儿童紫癜性肾炎的临床病理特点及预后分析[J]. 中国中西医结合肾病杂志, 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-Schönlein purpura[J]. Lancet, 2007, 369(9566): 976-978.
4. Soler MJ, Mir M, Rodriguez E, et al. Recurrence of IgA nephropathy and Henoch-Schönlein purpura after kidney transplantation: risk factors and graft survival[J]. Transplant Proc, 2005, 37(9): 3705-3709.
5. Fervenza FC. Henoch-Schönlein 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-Schönlein purpura nephritis?[J]. Kidney Int, 2001, 59(3): 823-834.
7. Almeida JL, Campos LM, Paim LB, et al. Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors[J]. Pediatr, 2004(83): 259-266.
8. 朱洪涛, 罗琼, 郭艳芳. 儿童过敏性紫癜肾炎的临床与病理相关性分析[J]. 新疆医科大学学报, 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-Schönlein 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-Schönlein 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. 韩媛, 黄松明, 张爱华, 等. 儿童紫癜性肾炎补体C4基因多态性分析[J]. 南京医科大学学报·自然科学版, 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-Schönlein 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. 黄丹琳, 许自川, 党西强, 等. 儿童紫癜性肾炎肾组织Th1/Th2比值与肾脏微血管损伤的关系[J]. 中国当代儿科杂志, 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. 杨军, 李成荣, 王国兵, 等. Th17细胞与CD4⁺ CD25⁺调节性T细胞在儿童过敏性紫癜发病机制中的作用[J]. 临床儿科杂志, 2009, 27(7): 645-648.
23. 丁艳, 刘玲, 董宗祈. 过敏性紫癜肾炎患儿血清细胞因子水平变化及意义[J]. 临床儿科杂志, 2005, 23(9): 643-645.
24. 潘凯丽, 白庆峰, 黄莹, 等. 过敏性紫癜患儿血清白细胞介素-4、-6、-8及肿瘤坏死因子-α表达的意义[J]. 实用儿科临床杂志, 2007, 22(21): 1632-1633.
25. 涂娟, 陈大坤, 曹力, 等. 过敏性紫癜患儿血小板表面黏附分子CD62P和GPⅡb/Ⅲa表达水平的变化[J]. 北京医学, 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. 王艳侠, 张爱平, 张颖玮, 等. 紫癜性肾炎患者血和肾组织P选择素的表达及意义[J]. 中华风湿病学杂志, 2003, 7(6): 343-345.
28. 崔玉霞, 刘若英, 李实光, 等. 过敏性紫癜患儿PBMC表面粘附分子表达、血清抗中性粒细胞胞浆抗体检测情况研究[J]. 临床儿科杂志, 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-Schönlein 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. 张洪霞, 刘雪梅, 柳方娥, 等. 过敏性紫癜患儿GPⅡb/Ⅲa、P-选择素及vWF检测的意义[J]. 山东大学学报·医学版, 2009, 47(1): 64-67.
32. 张爱娥, 云鹰. 过敏性紫癜肾炎凝血机制研究[J]. 医学综述, 2005, 11(2): 173-175.
33. Ozkaya O, Söylemezoğlu O, Gönen 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. 崔张莉, 石岩, 阴怀清, 等. 血管紧张素转换酶基因多态性与小儿过敏性紫癜及紫癜性肾炎的关联性[J]. 中国当代医药, 2010, 17(13): 5-8.
35. Amoli MM, Thomson W, Hajeer AH, et al. HLA-B35 association with nephritis in Henoch-Schönlein purpura[J]. J Rheumatol, 2002, 29(5): 948-949.
36. 任少敏, 锡林高娃,仝林虎, 等.内蒙地区汉族儿童HLA-DQAI基因与紫癜性肾炎的遗传易感性[J]. 中华肾脏病杂志, 2001, 17(4): 259.
37. 张洪霞. 小儿紫癜性肾炎的发病机制研究进展[J]. 中华现代儿科学杂志, 2008, 5(2): 126-129.
38. Syrjänen J, Hurme M, Lehtimäki 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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