实验室指标预测糖皮质激素治疗儿童原发性肾病综合征的疗效

Laboratory indicators predict the efficacy of glucocorticoid therapy in pediatric primary nephrotic syndrome

目的找到预测儿童原发性肾病综合征糖皮质激素治疗疗效的实验室指标。方法收集中山大学附属第一医院2012年2月-2021年12月期间初次确诊为原发性肾病综合征并且尚未使用激素治疗的患儿资料,包括一般临床资料及各项实验室检查结果,采用单因素分析、多因素logistic回归分析及列线图构建预测模型,并制作相应受试者工作特征曲线来确定危险因素的cutoff值。结果本研究纳入临床资料完整的原发性肾病综合征患儿病例174例,其中133例为激素敏感型肾病综合征(SSNS),41例为激素耐药型肾病综合征(SRNS),单因素分析结果显示:实验室检测指标中,尿视黄醇结合蛋白(RBP)、白细胞(WBC)、血小板计数/淋巴细胞百分比(PLpR)、纤维蛋白原(Fbg)、CD3^(+)%、CD3^(+)CD4^(+)%、补体3(C3)、补体4(C4)、性别这9个指标在SRNS和SSNS之间的差异有统计学意义(P<0.05)。将差异有统计学意义的危险指标运用多因素回归分析后,其中尿RBP、血WBC是独立危险预测因子。对尿RBP、血WBC进行受试者工作特征(ROC)曲线分析显示:尿RBP 0.47 mg/L与血WBC 12.19×109/L是预测儿童发生原发性肾病综合征激素耐药较好的诊断界限值。联合这2项指标构建的预测模型,ROC曲线下面积(AUC)为0.91,95%CI:0.87~0.96,敏感性:0.66,特异性:0.96。结论当尿RBP>0.47 mg/L且血WBC>12.19×109/L水平时,提示患儿发生激素耐药的风险较高。

Objective To find out the laboratory indicators that predict the efficacy of glucocorticoid therapy in pediatric primary nephrotic syndrome.Methods Data of children who were diagnosed with primary nephrotic syndrome for the first time from February 2012 to December 2021 in the First Affiliated Hospital of Sun Yat-sen University and have not been treated with glucocorticoid were collected,including general clinical data and various laboratory test results.Univariate analysis,multivariate logistic regression analysis and nomogram were used to construct a prediction model,and the corresponding receiver operating characteristic curve was made to determine the cutoff value of risk factors.Results A total of 174 children with primary nephrotic syndrome with complete clinical data were enrolled for the studies;of which,133 were steroid-sensitive nephrotic syndrome(SSNS)and 41 were steroid-resistant nephrotic syndrome(SRNS).The laboratory test indexes included urine retinol-binding protein(RBP),white blood cell(WBC),platelet-to-lymphocyte percentage ratio(PLpR),fibrinogen(Fbg),CD3^(+)%,CD3^(+)CD4^(+)%,complement 3(C3),complement 4(C4)and gender were collected and analyzed.There were significant differences in the above nine indicators between the SRNS group and the SSNS group(P<0.05).The urinary RBP and blood WBC were independent risk predictors.Receiver operating characteristic(ROC)curve analysis of urinary RBP and blood WBC showed that urinary RBP 0.47 mg/L and blood WBC 12.19×109/L were good diagnostic thresholds for predicting steroid resistance in children with primary nephrotic syndrome.When the prediction model was constructed by combining these two indicators,area under the curve(AUC)was 0.91(95%CI:0.87-0.96,sensitivity:0.66,specificity:0.96).Conclusion When the urinary RBP was higher than 0.47 mg/L and the WBC was higher than 12.19×109/L,it indicated that the children might at a higher risk of hormone resistance.