儿童过敏性紫癜血中标志物的检测及临床意义

Clinical significance of serum markers in Henoch-Schonlein purpura in children

目的探讨临床实验室常用检测指标对过敏性紫癜（HSP）患儿的临床应用价值。方法选取2015年1-7月于山东大学附属省立医院住院的HSP患儿108例（HSP组），按有无肾脏损害分为紫癜性肾炎组（HSPN组，70例）和非紫癜性肾炎组（NHSPN组，38例），并同时选取45名健康体检儿童作为对照组。分别应用半导体激光核酸荧光染色流式细胞术检测血常规，流式细胞仪免疫荧光法检测T淋巴细胞亚群、自然杀伤细胞、B淋巴细胞，散射比浊法检测血清免疫球蛋白（Ig）、血清补体，免疫比浊法检测D-二聚体，终点法检测24h尿蛋白。比较HSP组与对照组、HSPN组与NHSPN组白细胞计数、淋巴细胞百分比、中性粒细胞百分比、血小板计数、CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD3-CD19＋、CD16＋CD56＋、IgG、IgA、IgM、IgE、补体C3、补体C4、D-二聚体和24h尿蛋白。结果HSP组白细胞计数、淋巴细胞百分比、血小板计数、CD3＋CD8＋、CD3-CD19＋、IgA、IgE、补体C3、D-二聚体、24h尿蛋白均明显高于对照组[（8．7±3．5）×10^9／L比（5．9±1．6）×10^9／L、（39±16）％比（35±6）％、（275±79）×10^9／L比（219±65）×10^9／L、（30±6）％比（24±4）％、（19±10）％比（13±3）％、（2．5±1．1）g／L比（1．4±0．4）g/L、（170±168）kIU／L比（46±34）kIU／L、（1．30±0．32）g／L比（1．23±0．24）g／L、（1840±1720）μg／L比（260±120）μg／L、0．10（0．04，0．48）g比0．06（0．04，0．09）g]，CD3＋、CD3＋CD4＋、CD16＋CD56＋、IgG均明显低于对照组[（67±9）％比（81±5）％、（32．1±1．7）％比（52．6±3．3）％、（9±3）％比（15±5）％、（8．0±3．0）g／L比（8．7±1．3）g／L]，差异均有统计学意义（均P〈0．05）。HSPN组IgA、补体C3、D-二聚体、24h尿蛋白均明显高于NHSPN组，IgE和中性粒细胞百分比明显低于NHSPN组，差异均有统计学意义（均P〈0．05）。当白细胞计数为6．525×10^9／L时，诊断HSP的敏感度是73．33％，特异度是75．56％；当血小板计数为187×10^9／L时，诊断HSP的敏感度是91．33％，特异度是44．44％；当CD3＋CD8＋为25．93％时，诊断HSP的敏感度是77．19％，特异度是75．56％；当CD3-CD19＋为14．54％时，诊断HSP的敏感度是66．67％，特异度是80．00％；当IgA为1．575g／L时，诊断HSP的敏感度是84．26％，特异度是80．00％。结论HSP的发生和发展是一个综合的多因素复杂过程，存在免疫系统的失调，通过细胞免疫和体液免疫的检测能更好地了解了患儿的免疫功能，检测血常规、D-二聚体、24h尿蛋白对探讨HSP的发病机制和判断患儿预后有重要的临床价值。

Objective To analyze the clinical significance of serum markers in Henoch-Schonlein purpura （HSP） in children. Methods From January to July 2015, 108 children with HSP in Shandong Provincial Hospital Affiliated to Shandong University were enrolled （ HSP group） ; the children were divided into Henoch-Schonlein purpura nephritis（HSPN） group with 70 cases and non-HSPN（NHSPN） group with 38 cases; 45 healthy children were enrolled as control group. Blood routine was tested by semiconductor laser nucleic acid fluorescence staining flow cytometry; T lymphocyte subsets, natural killer cell and B lymphocyte were tested by flow cytometry immunofluorescence; serum immunoglobulin （Ig） and serum complement were tested by scattering turbidimetry; D-dimer was tested by immune turbidimetry ; 24 h urine protein was tested by end-point method. Leukocyte count,lymphocyte percentage, neutrophils percentage, platelet count, CD3＋, CD3＋CD4＋, CD3＋CD8＋, CD3-CD19＋, CD16＋CD56＋, IgG, IgA, IgM, IgE, complement C3, complement C4, D-dimer and 24 h urine protein were analyzed between groups. Results Leukocyte count, lymphocyte percentage, platelet count, CD3＋CD8＋, CD-CD19＋, IgA, IgE, complement C3, D-dimer and 24 h urine protein in HSP group were significantly higher than those in control group[ （8.7 ±3.5）×10^9/L vs （5.9 ± 1.6）× 10^9/L, （39 ± 16）% vs （35 ± 6）%, （275 ± 79） × 10^9/L vs （219±65） ×10^9/L,（30±6）% vs （24 ±4）%,（19±10）% vs （13 ±3）%,（2.5±1. 1）g/L vs （1.4± 0.4）g/L,（170 ± 168） kIU/L vs （46 ± 34） kIU/L, （1. 30 ± 0. 32） g/L vs （1.23 ± 0. 24） g/L, （ 1 840 ± 1 720 ） μg/L vs （ 260 ± 120 ） μg/L, 0.10 （ 0.04,0.48 ） g vs 0.06 （ 0.04,0.09 ） g ] （ P 〈 0.05 ） ; CD3＋, CD3＋ CD4＋, CD16＋ CD56＋ and IgG in HSP group were significantly lower than those in control group[ （67 ± 9）% vs （81 ± 5 ）%, （32.1±1.7）% vs （52.6±3.3）%,（9±3）% vs （15±5）%,（8.0±3.0）g/L vs （8.7±1.3）g/L]（P〈 0. 05 ）. IgA, complement C3, D-dimer and 24 h urine protein in HSPN group were significantly higher than those in NHSPN group; IgE and neutrophils percentage in HSPN group were significantly lower than those in NHSPN group（P 〈0. 05）. The sensitivity was 73.33% and specificity was 75.56% for diagnosing HSP according to the receiver operating characteristic curve analysis when leukocyte count was 6. 525 × 10^9/L; the sensitivity was 91. 33% and specificity was 44.44% when platelet count was 187 × 10^9/L; the sensitivity was 77.19% and specificity was 75.56% when CD3＋ CD8＋ was 25.93% ; the sensitivity was 66. 67% and specificity was 80. 00% when CD3- CD19＋ was 14.54% ; the sensitivity was 84.26% and specificity was 80.00% when IgA was 1. 575 g/L. Conclusions Blood routine, D-dimer, 24 h urine protein and immune function tests show clinical significance of exploring pathogenesis and improving prognosis in children with HSP.