儿童紫癜性肾炎ET-1、sVCAM-1及sIL-2R水平与病情严重程度和预后的相关性研究

Correlation of ET-1, sVCAM-1, and sIL-2R levels with disease severity and prognosis in children with Henoch-Schonlein purpura nephritis

摘要

目的 分析内皮素1(ET-1)、可溶性血管细胞黏附分子1(sVCAM-1)及可溶性白介素2受体(sIL-2R)水平与儿童紫癜性肾炎(HSPN)病情严重程度及预后的相关性。方法 2023年1月至2024年5月于本院入院的148例儿童HSPN患者作为HSPN组,根据HSPN患者病情将其分为轻度组(n=56)、中度组(n=63)与重度组(n=29),根据所有患儿6个月后的预后,分为完全缓解组(n=101)与持续异常组(n=47),持续异常组进一步分为轻微异常组(n=28)与严重异常组(n=19)两个亚组。采用单因素方差分析比较各组ET-1、sVCAM-1及sIL-2R水平,采用Spearman相关分析ET-1、sVCAM-1、sIL-2R与HSPN病情程度的相关性,并绘制受试者工作特征(ROC)曲线评估上述指标对患儿预后的预测价值。结果 在轻、中、重度组中,ET-1、sVCAM-1、sIL-2R水平均依次升高(F=31.569、22.446、15.089,均P<0.05);ET-1、sVCAM-1、sIL-2R与HSPN病情严重程度呈正相关(r_s=0.498、0.465、0.602,均P<0.05);完全缓解组ET-1、sVCAM-1、sIL-2R水平显著低于轻微异常组与严重异常组,且轻微异常组明显低于严重异常组(F=20.268、10.760、21.722,均P<0.05);ET-1、sVCAM-1、sIL-2R及三项联合预测HSPN患儿严重程度的曲线下面积(AUC)分别为0.740(95%CI:0.651~0.829)、0.753(95%CI:0.664~0.842)、0.729(95%CI:0.637~0.820)、0.914(95%CI:0.863~0.964),联合预测灵敏度89.40%,特异度88.12%。结论 ET-1、sVCAM-1、sIL-2R与儿童紫癜性肾炎病情严重程度密切相关,联合预测紫癜性肾炎患儿严重程度具有较高效能。

Abstract

Objective To analyze the correlation between the levels of endothelin-1 (ET-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble interleukin-2 receptor (sIL-2R) and the severity and prognosis of Henoch-Schonlein purpura nephritis (HSPN) in children. Methods A total of 148 children with HSPN (HSPN group) were enrolled in the study. According to the severity, children with HSPN were divided into mild group, moderate group, and severe group. Six months later, they were divided into complete remission group and persistent abnormality group according to the prognosis. Children in the persistent abnormality group were divided into two subgroups, namely mild abnormality group and severe abnormality group. The levels of ET-1, sVCAM-1 and sIL-2R were compared between groups. The correlation between ET-1, sVCAM-1, sIL-2R and the severity of HSPN, and their predictive value for persistent abnormality were analyzed. Results The levels of ET-1, sVCAM-1 and sIL-2R in the severe group, the moderate group, and the mild group decreased in order (F=31.569, 22.446 and 15.089, respectively, P<0.001). ET-1, sVCAM-1, and sIL-2R were positively correlated with the severity of HSPN (r_s=0.498, 0.465 and 0.602, respectively, P<0.001). The levels of ET-1, sVCAM-1 and sIL-2R were significantly lower in the complete remission group than in the mild abnormality group and the severe abnormality group, and significantly lower in the mild abnormality group than in the severe abnormality group (F=20.268, 10.760 and 21.722, respectively, P<0.001). The areas under the curve (AUCs) of ET-1, sVCAM-1, sIL-2R, and their combination for predicting persistent abnormality were 0.740 (95%CI:0.651-0.829), 0.753 (95%CI:0.664-0.842), 0.729 (95%CI:0.637-0.820), 0.914 (95%CI:0.863-0.964), respectively. The sensitivity and specificity of joint prediction were 89.40% and 88.12%, respectively. Conclusion ET-1, sVCAM-1, and sIL-2R are closely related to the severity of HSPN in children, and their combination demonstrates high efficacy for predicting persistent abnormality in children with HSPN.

关键词

儿童 / 过敏性紫癜 / 紫癜性肾炎 / 内皮素1 / 可溶性血管细胞黏附分子1 / 可溶性白介素2受体 / 预后

Key words

child / Henoch-Schonlein purpura / Henoch-Schonlein purpura nephritis / Endothelin-1 / soluble vascular cell adhesion molecule-1 / soluble interleukin-2 receptor / prognosis

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基金资助

金华市科技局重点项目(2022-3-130)