红细胞分布宽度与儿童过敏性紫癜肾炎病情预后的相关性分析

Association analysis between red blood cell distribution width and prognosis of Henoch-Schönlein purpura nephritis in children

目的探讨红细胞分布宽度(RDW)与儿童过敏性紫癜肾炎(HSPN)病情轻重程度的相关性。方法回顾性分析2016年1月至2018年12月在郑州大学附属儿童医院肾脏风湿科住院的HSPN病儿的资料,同时以同期健康体检儿童作为对照组。分析HSPN病儿在入院时和对照组在体检时的白细胞计数、血红蛋白、血小板、RDW、红细胞沉降率(ESR)和24 h尿蛋白定量。同时根据肾活检肾小球病理的分级标准,比较不同病理分级HSPN病儿的临床及实验室检测指标。结果两组资料共纳入182例,其中HSPN病儿82例,健康对照组100例。HSPN组病儿的白细胞[(11.50±4.12)×10^(9)/L比(6.60±1.18)×10^(9)/L]、血小板[(270±96)×10^(9)/L比(227±73)×10^(9)/L]、RDW[(13.30±0.49)%比(13.08±0.73)%]和ESR[(12±4)mm/h比(7±2)mm/h]均明显高于健康对照组(P<0.05)。白细胞、血小板、ESR在不同病理分级病儿中差异无统计学意义(P>0.05),而血红蛋白、RDW和24 h尿蛋白定量则差异有统计学意义(P<0.05)。logistic回归分析后显示RDW(OR=5.787,P=0.021)和24 h尿蛋白定量(OR=1.046,P=0.008)是HSPN病儿肾活检病理分级轻重程度的危险因素。ROC曲线显示曲线下面积为0.793,P<0.001;当截点为13.35%时,RDW预测HSPN病儿不同肾活检病理分级轻重程度的灵敏度为62.3%,特异度为90.5%。RDW水平在肾病水平蛋白尿组中明显高于非肾病水平蛋白尿组(P<0.001),RDW与24 h尿蛋白定量呈正相关性(r=0.454,P<0.001)。结论RDW在HSPN病儿中升高,可作为HSPN病儿病情轻重程度评估的早期预警标志物。

Objective To investigate the association between red blood cell distribution width(RDW)and prognosis of Henoch-Schönlein purpuric nephritis(HSPN)in children.Methods The data from hospitalized HSPN patients from January 2016 to December 2018 in the Department of Nephrology and Rheumatology of Children's Hospital Affiliated to Zhengzhou University were retrospective analyzed,and healthy children who underwent physical examination during the same period were selected as the control group.White blood cell(WBC)counts,hemoglobin(HGB),platelet(PLT),RDW,erythrocyte sedimentation rate(ESR),and 24-hour urine protein lev⁃el were analyzed at admission for HSNP patients and the control group children.According to the grade criteria of renal biopsy patholo⁃gy,the clinical data and laboratory test indicators of children with different pathological grades of HSPN were compared.Results A to⁃tal of 182 cases were included in the two groups,including 82 children with HSPN and 100 healthy children.The WBC[(11.50±4.12)×10^(9)/L vs.(6.60±1.18)×10^(9)/L],PLT[(270±96)×10^(9)/L vs.(227±73)×10^(9)/L],RDW[(13.30±0.49)%vs.(13.08±0.73)%],and ESR[(12±4)mm/h vs.(7±2)mm/h]in the HSPN group were significantly higher than those in the healthy control group(P<0.05).There was no signif⁃icant difference in WBC,PLT and ESR in children with different pathological grades(P>0.05),while there were statistical differences in HGB,RDW and 24h urine protein level(P<0.05).Logistic regression analysis showed that RDW(OR=5.787,P=0.021)and 24h urine protein level(OR=1.046,P=0.008)were risk factors for different grades of renal biopsy in HSPN children.The ROC curve showed that the area under the curve was 0.793,P<0.001,when the cut-off value was 13.35%,the sensitivity of RDW in predicting the different renal biopsy pathological grades in children with HSPN was 62.3%,and the specificity was 90.5%.The level of RDW in the nephrotic range proteinuria group was significantly higher than that in the non-nephrotic range proteinuria group(P<0.001).There was a positive correlation between RDW and 24h urine protein level(r=0.454,P<0.001).Conclusion RDW is elevated in children with HSPN,and it might be an early warning marker for the assessment of HSPN in children.