半乳糖缺陷IgA1在儿童紫癜性肾炎早期诊断中的意义

Value of galactose-deficient IgA1 in the early diagnosis of Henoch-Schonlein purpura nephritis in children

目的探讨半乳糖缺陷IgA1(Gd-IgA1)在儿童紫癜性肾炎(HSPN)早期诊断中的价值。方法以2018年1～4月确诊为HSPN的住院患儿67例、过敏性紫癜(HSP)住院患儿58例为研究对象,另选取20例行健康体检儿童作为健康对照组。采用ELISA法检测血清、尿液Gd-IgA1水平。以受试者工作特征曲线(ROC)分析血清Gd-IgA1及尿液Gd-IgA1/尿肌酐比值对HSPN的诊断价值。结果 HSP及HSPN患儿血清Gd-IgA1、尿液Gd-IgA1/尿肌酐比值均高于健康对照组(P<0.01),且以HSPN患儿升高更明显(P<0.01)。血清Gd-IgA1水平≥1 485.57 U/mL和/或尿液Gd-IgA1/尿肌酐比值≥105.74时,对诊断HSPN有较好的意义。49例HSP患儿随访6个月,随访中HSPN发病率为47%(23/49);其中,血清Gd-IgA1≥1 485.57 U/mL患儿HSPN发病率为100%,尿液Gd-IgA1/尿肌酐比值≥105.74患儿HSPN发病率为73%。结论血清及尿液Gd-IgA1对HSPN的早期诊断有较好的临床价值。

Objective To explore the value of galactose-deficient IgA1(Gd-IgA1) in the early diagnosis of Henoch-Sch?nlein purpura nephritis(HSPN) in children. Methods A total of 67 hospitalized children who were definitely diagnosed with HSPN between January and April 2018 and 58 hospitalized children with Henoch-Sch?nlein purpura(HSP) were enrolled in the study. Twenty children undergoing routine physical examinations served as controls. The levels of serum and urine Gd-IgA1 were determined using ELISA. The receiver operating characteristic curve was used to analyze the value of serum Gd-IgA1 and urine Gd-IgA1/urine creatinine ratio in the diagnosis of HSPN. Results The level of serum Gd-IgA1 and urine Gd-IgA1/urine creatinine ratio in children with HSP or HSPN were significantly higher than those in healthy control group(P<0.01), with a significantly greater increase observed in children with HSPN(P<0.01). Serum Gd-IgA1 ≥1 485.57 U/mL and/or urine Gd-IgA1/urine creatinine ratio ≥105.74 were of favorable value in the diagnosis of HSPN. During the six-month follow-up of the 49 children with HSP, the incidence of HSPN was 47%(23/49), which included a 100% incidence in children with serum Gd-IgA1 ≥1 485.57 U/mL and a 73% incidence in children with urine Gd-IgA1/urine creatinine ratio ≥105.74. Conclusions Serum and urine Gd-IgA1 is of favorable clinical value in the early diagnosis of HSPN.