生物学标志物对儿童过敏性紫癜诊断价值的评价

Values of different biomarkers for diagnosis of Henoch-Sch?nlein purpura in children

目的筛选辅助检查儿童过敏性紫癜(HSP)的生物学标志物,并用ROC曲线评价各生物学标志物对诊断HSP的价值。方法选取2012年4月至2014年3月诊断为HSP的127例患儿为研究对象,另选取健康儿童127例为对照组,检测两组儿童血清淀粉样蛋白A(SAA)、白细胞介素(IL)-6、免疫球蛋白(Ig)A、Ig G、Ig M、Ig E、C反应蛋白(CRP)、白细胞(WBC)计数、补体(C3、C4)、抗链球菌溶血素O(ASO)和血清铁蛋白(Fer)等12项生物学指标水平。受试者工作特征曲线(ROC)分析所筛选标志物对HSP的诊断价值。结果 HSP患者SAA、IL-6、CRP、WBC、Ig A和Ig M等6项指标水平显著高于对照组(P<0.05)。其中5项指标(SAA、IL-6、WBC、Ig A和Ig M)的ROC曲线下面积(AUC)均>0.7,且差异有统计学意义(P<0.05)。当SAA最佳临界值为3.035μg/m L时,敏感度为95.1%,特异度为90.2%;当Ig A为1 579.5 mg/L时,敏感度为75.6%,特异度为85.4%;当Ig M为922.5 mg/L时,敏感度为72.3%,特异度为82.4%;当WBC计数为8.850×109/L时,敏感度为78.0%,特异度为70.7%;当IL-6为7.035 pg/m L时,敏感度为63.4%,特异度为80.5%。结论 SAA、IL-6、WBC、Ig A和Ig M对诊断HSP具有一定的诊断价值,SAA的诊断价值最高。

Objective To screen biomarkers which can be used as an auxiliary method in the diagnosis of Henoch-Sch？nlein purpura （HSP） and to evaluate their diagnostic values by receiver operating characteristic （ROC） curve analysis. Methods A total of 127 children diagnosed with HSP between April 2012 and March 2014 were included in the HSP group and an equal number of healthy children were included in the control group. Twelve parameters, i.e., serum amyloid protein A （SAA）, interleukin-6 （IL-6）, immunoglobulins （IgA, IgG, IgM, and IgE）, C-reactive protein （CRP）, white blood cell （WBC） count, complements C3 and C4, anti-streptolysin O, and ferritin, were analyzed. The values of the screened biomarkers for diagnosis of HSP were assessed by ROC curve analysis. Results The HSP group had signiifcantly higher levels of SAA, IL-6, CRP, WBC, IgA, and IgM than the control group （P〈0.05）. The areas under the ROC curve of SAA, IL-6, WBC, IgA, and IgM for the diagnosis of HSP were higher than 0.7 （P〈0.05）. The optimal cut-off values of SAA, IgA, IgM, WBC, and IL-6 for the diagnosis of HSP were 3.035μg/mL, 1 579.5 mg/L, 922.5 mg/L, 8.850×109/L, and 7.035 pg/mL, respectively; the corresponding sensitivities of the optimal cut-off values for the diagnosis of HSP were 95.1%, 75.6%, 72.3%, 78.0%, and 63.4%, respectively, and the corresponding speciifcities were 90.2%, 85.4%, 82.4%, 70.7%, and 80.5%, respectively. Conclusions SAA, IgA, IgM, WBC, and IL-6 are valuable biomarkers for clinical diagnosis of HSP and among them SAA seems to be the best one.