体液免疫及血管炎指标对HSP的诊断价值分析

Analysis of the value of humoral immunity and vasculitis biomarkers for diagnosis of Henoch-Schonlein purpura

目的分析儿童过敏性紫癜（HSP）患者的血管炎及免疫球蛋白等生物学指标，用ROC曲线评价目标生物学指标诊断HSP的价值。方法以2013年1月至2015年12月住院诊断HSP的66例患者为研究对象，另选取同期健康儿童60例为对照组。分析HSP患者的临床表现、过敏原检测结果；检测两组儿童血管炎四项[抗中性粒细胞胞浆抗体核周型（p-ANCA）、抗中性粒细胞胞浆抗体胞浆型（c—ANCA）、抗心磷脂抗体IgG（ACLIgG）、抗心磷脂抗体IgM（ACLIgM）]、体液免疫指标（IgE、IgA、IgM）、CRP、WBC、尿蛋白、尿红细胞等11项生物学指标。采用SPSS21．0软件进行受试者工作特征曲线（ROC）统计分析生物学指标对HSP的诊断价值。结果（1）HSP组IgE、IgA、p-ANCA、c—ANCA、ACLIgG、ACLIgM、WBC、尿蛋白、尿红细胞9项生物学指标均显著高于健康对照组（P〈0．05）；（2）ROC曲线分析结果提示血清IgA、尿红细胞的AUG均〉0．7，差异有统计学意义（P〈0．05）；（3）11项列入研究的生物学指标中，IgA的敏感度为0．875，特异度为1．000，最佳临界点是1．310。结论血清IgA、尿红细胞对诊断HSP有一定的诊断价值，其中IgA的诊断价值最高。

Objective To analyze the biomarkers ofHenoch-SchSnlein purpura （HSP） patients, including four items of vasculitis and immunoglobulin, and to evaluate their diagnostic value by receiver operating characteristic （ROC） curve. Methods 66 children diagnosed with HSP between January 2013 and December 2015 were included in HSP group, and 60 healthy children were included in control group. The clinical manifestation and allergen detection results were analyzed. Eleven parameters, i.e., four items of vasculitis including p-ANCA, c-ANCA, ACLIgG, ACLIgM, humoral immunity index including IgE, IgA, IgM, C-reactive protein （CRP）, white blood cell count （WBC）, urine protein, urine red blood cell count were analyzed. The value of screened biomarkers for diagnosis of HSP was assessed by ROC curve analysis from SPSS21.0. Results （1）The levels of IgE, IgA, p-ANCA, c-ANCA, ACLIgG, ACLIgM, WBC, urine protein, urine red blood cell count in HSP group were significantly higher than those in control group （P〈0.05）. （2）The analysis result of ROC curve suggested that the area under curve （AUC） of serum IgA and urine red blood cell count for the diagnosis of HSP were higher than 0.7 （P〈0.05）. （3）Among 11 biomarkers recruited in this investigation, the sensitivity of IgA was 0.875, the specificity was 1.000, the optimal cut-offvalue was 1.310. Conclusion Serum IgA and urine red blood cell count are valuable biomarkers for clinical diagnosis of HSP, and among them serum IgA devotes the best value.