尿微量蛋白检测对预测儿童过敏性紫癜肾损伤的意义

The significance of urinary microprotein detection in predicting renal injury in children with Henoch-Schonlein purpura

目的分析尿微量蛋白检测对儿童过敏性紫癜(HSP)肾损伤的早期诊断意义。方法选取2014年11月1日至2017年8月31日在西安交通大学第二附属医院住院的HSP患儿60例,按照尿常规结果的异常程度分为尿检重度异常组、尿检轻度异常组、尿检无异常组。选取同龄健康体检儿童27例为对照组。使用酶联免疫检测仪检测尿视黄醇结合蛋白(RBP)、尿N-乙酰-β-D-氨基-葡萄糖苷酶(NAG)、尿Ⅳ胶原蛋白的水平,生化方法检测D-二聚体(D-D)结果,绘制ROC曲线。结果尿RBP、尿NAG、尿Ⅳ胶原蛋白水平在尿检重度异常组、尿检轻度异常组、尿检无异常组、对照组间比较,差异均有统计学意义(F值分别为88.003、23.484、28.400,均P<0.05),BUN、Scr水平4组间比较差异均无统计学意义(均P>0.05),D-D水平在4组间比较差异有统计学意义(P<0.05),但尿检轻度异常组与尿检重度异常组比较差异无统计学意义(P>0.05)。相关性分析结果显示尿RBP水平与尿NAG、尿Ⅳ胶原蛋白水平呈正相关(相关系数r分别为0.603、0.588,均P<0.05),尿NAG水平与尿Ⅳ胶原蛋白水平也呈正相关(相关系数r=0.507,P<0.05)。尿RBP的曲线下面积(AUC)为0.819(95%CI:0.687~0.951,P<0.05),尿Ⅳ胶原蛋白的AUC为0.727(95%CI:0.609~0.845,P<0.05),尿NAG的AUC为0.665(95%CI:0.537~0.792,P<0.05),诊断效能方面尿RBP>尿Ⅳ胶原蛋白>尿NAG。结论尿RBP、尿NAG、尿Ⅳ胶原蛋白、D-D同时检测可早期预警HSP患儿肾脏的损害,为临床医生及时治疗提供依据。

Objective To study the significance of urine microprotein in predicting renal injury of children with Henoch-Schonlein purpura.Methods 60 children with Henoch-Schonlein purpura(HSP) and hospitalized in the Second Affiliated Hospital of Medical College of Xi’an Jiaotong University from November 2014 to August 2017 were selected.All of them were divided into severe abnormal group,mild abnormal group and no abnormal group according to the abnormal degree of laboratory urine routine results.Twenty-seven healthy children of the same age were selected as the control group.The levels of urinary retinol binding protein(RBP),urinary N-acetyl-β-D-glucosidase(NAG) and urinary Ⅳ collagen were detected by Elisa,and the results of D-D were detected by Biochemical methods.Then the ROC curve was performed.Results There were significant differences in urinary RBP,urinary NAG,urinary Ⅳ collagen levels among severely abnormal urinary test group,mildly abnormal urine test group,normal group and the control group(F values were 88.003,23.484 and 28.400,respectively,both P<0.05),but no significant differences was found in the levels of BUN and Scr among those four groups(all P>0.05).And the D-D difference among the four groups was statistically significant(P<0.05),but not statistically significant between severe abnormal group,mild abnormal group(P>0.05).Correlation analysis showed that urinary RBP level were positively correlated with urinary NAG,urinary Ⅳ collagen levels(r=0.603 and 0.588,respectively,all P<0.05),and urinary NAG levels also were positively correlated with urinary Ⅳ collagen levels(r=0.507,P<0.05).The area under curve(AUC) of urinary RBP was 0.819(95%CI:0.687-0.951,P<0.05),AUC of urinary collagen Ⅳ was 0.727(95%CI:0.609-0.845,P<0.05),and AUC of urinary NAG was 0.665(95%CI:0.537-0.792,P<0.05).The diagnostic efficiency of urinary RBP was the best,following by urinary Ⅳ collagen times,while urinary NAG was the lowest.Conclusion The combined detection of urinary RBP,urinary NAG,urinary Ⅳ and D-D can early detect renal damage in children with allergic purpura,and provide basis for clinicians to timely treatment.