engleski

Erythrocyte glutathione S-transferase activity in children with Henoch-Schönlein purpura

Introduction: Henoch-Schönlein purpura (HSP) is the most common vasculitis of the childhood. Among all possible symptoms / complications, nephritis (HSPN) is the main and almost only cause of morbidity and mortality in HSP. Objectives: The aim of this study was to investigate the value of erythrocyte glutathione S-transferase (e-GST) activity as an early predictor of nephritis development in HSP. Methods: Ninety-seven children with HSP were enrolled into the study. The control group consisted of 52 children without clinical and laboratory signs of inflammation. In all patients e-GST activity was determined spectrometrically for three times during six- month period and corelated with clinical characteristics of the disease, routine blood and urine laboratory findings as well as with e-GST activity in healthy children. Results: At the beginning of the disease the e- GST activity values were significantly higher in the group of HSP patients who developed proteinuria above 0.15 g/dU and/or haematuria above 5 E/mm3 (i.e. HSPN) during six-month follow-up period, compared to the group of HSP patients without nephritis during same time span: median (interquartile range) 5, 70 U/gHb (4, 38-7, 50 U/gHb) compared to 3, 10 U/gHb (2, 20- 4, 20 U/gHb) ; P<0, 001. Similar results were obtained after the comparison of the patients with HSPN and control group: 5, 70 U/gHb (4, 38- 7, 50 U/gHb) vs. 3, 13 U/gHb (1, 91-4, 20 U/gHb) ; P<0, 001. There were no statistically significant differences between the group of HSP patients without nephritis and a control group (P=0, 837). After the period of three and six months, a decrease of e-GST activity was observed in the HSPN patients, but it was still significantly higher compared to the group of HSP patients without nephritis (P<0, 001 / P<0, 001). In the ROC analysis of the e-GST activity determination value in the prediction of HSP nephritis, for the e-GST values >4, 1 U/gHb a significant area under the curve (AUC) of 91.1% (P < 0.001) and sensitivity of 90.5% and specificity of 72.7% was found at the beginning of the study. The sensitivity of the nephritis detection tests decreased, and the specificity increased during the follow-up period. No significant correlation between e-GST activity and severity of skin changes, abdominal pain and arthralgia/arthritis, or used therapy was found. Among the routine laboratory tests, a consistent, statistically significant, positive correlation was found only between e- GST activity and the number of erythrocytes per mm3 in urine samples.

Erythrocyte glutathione S-transferase activity ; Henoch-Schönlein purpura

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