RDW、NLR、TNF-α检测对儿童过敏性紫癜肾损伤的临床价值

Clinical value of detection of RDW,NLR and TNF-αon renal injury of henoch-schonlein purpura

目的研究中性粒细胞/淋巴细胞比值(NLR)、红细胞分布宽度(RDW)、肿瘤坏死因子-α(TNF-α)对儿童过敏性紫癜肾损伤的临床价值。方法选取2017年8月至2019年12月在西安市第一医院诊治的88名过敏性紫癜患儿为病例组,同时选取同院同期进行健康体检的27名儿童作为对照组,收集两组儿童的一般资料和实验室检查结果。根据尿常规结果将病例组分为尿检异常组及尿检无异常组,根据尿微量白蛋白(mALB)值将病例组分为肾损A组、肾损B组、非肾损C组,采用Pearson相关及受试者工作特征(ROC)曲线分析RDW、NLR、TNF-α诊断肾脏损害效能。结果病例组的RDW、NLR、C-反应蛋白(CRP)、TNF-α水平均高于对照组,差异有统计学意义(F值分别为3.374、3.778、4.878、3.280,P<0.05);尿检异常组的钙离子水平低于尿检无异常组,差异有统计学意义(t=-3.305,P<0.05);肾损A组及B组的RDW、NLR、CRP、TNF-α水平均高于非肾损C组,钙离子水平低于非肾损C组,差异有统计学意义(F值分别为3.860、3.441、3.783、7.903、4.424,P<0.05);患儿尿mALB水平与RDW、NLR、TNF-α水平呈正相关关系(r值分别为0.212、0.292、0.224,P<0.05);ROC曲线分析显示,RDW、NLR、TNF-α及三组联合诊断的曲线下面积分别为0.676、0.647、0.719、0.993,P<0.05。结论NLR、RDW、TNF-α检测在过敏性紫癜儿童肾损伤的临床预测中有一定的价值,三者联合诊断效能更高。

Objective To investigate the clinical value of neutrophil/lymphocyte ratio(NLR),red blood cell distribution width(RDW),and tumor necrosis factor-α(TNF-α)in children with renal injury of henoch-schonlein purpura.Methods A total of 88 children with henoch-schonlein purpura treated in Xi′an No.1 Hospital from August 2017 to December 2019 were selected as the case group,and 27 children who underwent physical examination at the same time were selected as the control group.General data and laboratory examination results of the two groups of children were collected.The case group was divided into abnormal urine routine group and no abnormal urine routine group according to routine urine test results.The case group was divided into renal injury group A,renal injury group B,and non-renal injury group C according to urinary microalbumin(mALB)value.The efficacy of RDW,NLR,TNF-α in diagnosing renal injury was analyzed by Pearson correlation and receiver operating characteristic(ROC)curve.Results The RDW,NLR,C-reactive protein(CRP)and TNF-α levels in the case group were higher than those in the control group,the differences were statistically significant(F=3.374,3.778,4.878 and 3.280,respectively,P<0.05).Calcium ion level in the abnormal urine routine group was lower than that in the no abnormal urine routine group,and the difference was statistically significant(t=-3.305,P<0.05).The levels of RDW,NLR,CRP,and TNF-α in renal injury group A and B were higher than those in non-renal injury group C,and the levels of calcium ion were lower than those in non-renal injury group C,the differences were statistically significant(F=3.860,3.441,3.783,7.903 and 4.424,respectively,P<0.05).There was positive correlations between urinary mALB level and RDW,NLR and TNF-α levels(r=0.212,0.292 and 0.224,respectively,P<0.05).ROC curve analysis showed that the areas under ROC curve of RDW,NLR,TNF-α,and the three groups of combined diagnosis were 0.676,0.647,0.719 and 0.993,respectively,P<0.05.Conclusion The detection of NLR,RDW,and TNF-α has a certain value in clinical prediction of renal injury in children with henoch-schonlein purpura,and the combined diagnosis of NLR,RDW,and TNF-α has higher diagnostic efficiency.