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Objectives To detect the level of soluble programmed death 1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) in serum and urine of children with primary nephrotic syndrome (PNS),and explore its clinical significance.Methods From July 2017 to November 2017,children with PNS admitted to the Children's Hospital Affiliated to Soochow University were divided into onset group (36 cases) and remission group (33 cases).Thirty healthy children who underwent medical examination for enrollment,undersize or overweight in the outpatient department of pediatric health care and inpatient department of Endocrinology were selected as healthy control group.Serum and urine samples were collected,in which the levels of sPD-1 and sPD-L1 were detected by enzyme-linked immunosorbent assay (ELISA).The correlation between serum and urine sPD-1,sPD-L1 levels and lymphocyte subsets,urinary protein were analyzed by Pearson and Spearman correlation analysis.Results The level of sPD-1 in serum was lower in remission group than those in healthy controlgroup [1.60(0.48,8.15) ng/ml vs 7.38(2.15,19.02) ng/ml,P ＜ 0.01].The level of urinary sPD-1 in onset group was higher than that in remission group [1.21(0.61,2.56) pg/μg vs 0.51(0.31,0.97) pg/μg,P ＜0.001] and healthy control group [1.21(0.61,2.56) pg/μg vs 0.82(0.34,1.15) pg/μg,P ＜ 0.01].The levels of sPD-L1 in serum and urine were higher in onset and remission group than those in healthy control group (P ＜ 0.001).The level of sPD-1 in the serum was positive correlated with the numbers of CD3+,CD3+CD4+,CD3+ CD8+ T lymphocytes and CD3-CD19+,CD19+CD23+ B lymphocytes (r=0.537,0.478,0.454,0.429 and 0.374;P=0.002,0.008,0.012,0.018 and 0.042).The level of sPD-1 in the urine had positive relation with the ratio of 24 hours urinary albumin and weight (24 h UmAlb/Wt),N-acetylglucosaminidase and urinary creatinine (UNAG/Cr) and β2 microglobulin and urinary creatinine (Uβ2MG/Cr) (r=0.409,0.588 and 0.276;P=0.016,0.000 and 0.032).Conclusions The dynamic changes of sPD-1 and sPD-L1 in serum and urine suggested that PD-1/PD-L1 signaling pathway is involved in the development process of childhood primary nephrotic syndrome.
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Objective To explore the correlations of soluble thrombomodulin (sTM) and high sensitive C reactive protein(hs-CRP) levels with the hypercoagulable state and indicators of predicting thrombosis in children with primary nephrotic syndrome(PNS).Methods Sixty-four PNS patients who had primary clinical diagnosis or recurrence after hormone withdrawal for 6 months or more hospitalized in Department of Urology,the Second Children's Hospital of Tianjin from January 2010 to January 2014 were selected as PNS group.Thirty patients with inguinal hernia undergoing elective surgery hospitalized in Department of Surgery,the Second Children's Hospital of Tianjin from January 2010 to January 2014 were selected as control group.All the selected patients were extracted for venous blood samples,and the double-antibody sandwich enzyme-linked immunosorbent assay was used to detect plasma sTM levels,while immunoturbidimetric assay was used to detect plasma hs-CRP levels;the indicators of predicting thrombosis as blood lipid and fibrinogen(Fb) etc.were simultaneously detected.Inspection results were compared and the correlation was analyzed by using statistical methods.Results The level of plasma sTM in children with PNS was significantly higher than that in the control group[(1.63 ±0.68) μg/L vs.(0.30 ±0.24) μg/L],and the difference was statistically significant between the 2 groups (t =12.545,P ＜ 0.05).The level of plasma sTM in PNS group with urine protein negative was significantly lower than that before hormone treatment[(1.05 ± 0.56) μg/L vs.(1.63 ± 0.68) μg/L],and there was a statistically significant difference(t =6.298,P ＜ 0.05).The level of plasma sTM in children with PNS had positive correlation with 24 h urinary protein,low density lipoprotein,apolipoprotein B,lipoprotein a and Fb (r =0.379,0.203,0.184,0.177,0.224,all P ＜ 0.05).The level of plasma hs-CRP in children with PNS was significantly higher than that in the control group [(1.9 ± 1.7) mg/L vs.(0.7 ± 0.6) mg/L],and the difference was statistically significant between the 2 groups (t =3.487,P ＜ 0.05).In PNS group,the level of plasma hs-CRP with urine protein negative was significandy lower than that before hormone treatment[(0.4 ±0.3) mg/L vs.(1.9 ± 1.7) mg/L],and there was a statistically significant difference (t =5.473,P ＜ 0.05).The level of plasma hs-CRP in children with PNS was negatively correlated with plasma albumin (r =-0.194,P ＜ 0.05),but positively correlated with Fb (r =0.257,P ＜ 0.01).Plasma sTM and hs-CRP levels in children with PNS were positively correlated (r =0.395,P ＜ 0.05).Conclusions sTM involves in the formation process of PNS hypercoagulable state possibly through dual influencing by blood coagulation process and blood lipids.sTM may be used as one of the reference indicators for PNS activity and prediction of thrombosis.Plasma hs-CRP reflects the micro-inflammatory state in children with PNS,and involves in the formation of hypercoagulability by effecting blood coagulation process,and should be used as indicators for monitoring the hypercoagulability of active PNS.
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Objective To investigate the association of platelet activating factor acetylhydrolase(PAF-AH) activity in children with primary nephrotic syndrome(PNS).Methods The plasma PAF-AH activity was measured in 78 children with PNS who were divided into 3 groups:steroid-responsive nephritic,steroid-dependent nephritic,steroid-resistent nephritic,after they had been given steroid for 6 months.The plasma PAF-AH activity were also measured in 60 healthy children at the same age,with spectrophotometric assay,at the ame time,the blood cholesterol was measured.Results The blood cholesterol has positive correlation with the plasma PAF-AH activity,there was no significant difference of the blood cholesterol among 3 groups in nephrotic syndrome children,there was a significant difference in the plasma PAF-AH activity among 3 groups in PNS children,but there was no significant difference in the plasma PAF-AH activity between the groups of steroid-responsive nephritic and healthy children.Conclusion Plasma PAF-AH activity is related to the sensibility to steroid treatment in children′s PNS,and the plasma PAF-AH activity in steroid-resistent nephritic is higher than steroid-dependent nephritic.It is a question that if gene mutation is related with PAF-AH activity.
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Objective To investigate the Th1/Th2 cells imbalance in childhood primary nephrotic syndrome(PNS)and its relation to disease activity. Methods Percentage of T-helper-1(Th1) and T-helper-2 (Th2) cells was examined by three-color flow-cytometry in 21 cases of first-onset PNS, 16 cases of remission PNS and 10 healthy children. Results The percentage of Th1, Th2 and Th0 cells in healthy children was (13. 42?4. 36)% , (2. 53 ? 1. 97)% and (1. 25?0. 92)% respectively. In the patients with first-onset PNS, the percentage of Th1, Th2 and Th0 cells was significantly decreased as compared to healthy children [(2. 34 ?2. 09)%, (1.02?0.96)% and (0.40?0.38)% respectively, all P 0. 05]. Because of relatively low percentage of Th1 cells in contrast to Th2 cells in the patients with first-onset PNS, Th1/Th2 ratio was also significantly reduced in those patients, as compared to the patients with remission PNS and the healthy children (2. 43 ? 2.65 vs 4. 17?2. 32 and 5. 41?2. 77, both P
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Objective To study the change of the level of serum leptin in children with primary nephritic syndrome(PNS)treated with glucocorticosteroid.Methods Totally 30 PNS patients and 26 healthy children in whom were a matchable age,sex and body mass index(BMI)with the PNS patients were recruited in this study.The PNS patients were treated with prednisone in middle-term or long-term coure of treatment.Serum leptin and BMI of PNS patients were abserved before treatment,after 2,6 months treatment and in the end.The se-rum total cholesteroc(TC)and triglyeride(TG)were abserved in PNS patients after 2,6 months treatment and in the end.Results The se-rum leptin level was(2.75?2.29)?g/L in the PNS patient before treatment and control group was(2.65?2.22)?g/L.There was not significantly different between the PNS patient and control group.The level of serum leptin after 2 months treatment was(9.29?7.19)?g/L and BMI was(18.12?1.90)kg/m2.They were higher than that in control group,6 months treatment and in the end(Pa