D-二聚体与免疫球蛋白A比值对初诊伴胃肠道受累的过敏性紫癜患儿急性期肾损害的评估价值

Value of D-dimer to immunoglobulin A ratio in evaluating renal impairment in acute phase in Henoch-Sch?nlein purpura children complicated with gastrointestinal involvement at initial diagnosis

目的探讨D-二聚体(D-D)、免疫球蛋白A(IgA)、D-D与IgA比值(D-D/IgA)与初诊时伴有胃肠道受累的过敏性紫癜(HSP)患儿急性期肾脏损害的关系。方法对148例初诊HSP患儿进行回顾性分析,根据临床表现分为无胃肠道受累组78例和胃肠道受累组70例。将胃肠道受累组根据急性期肾脏损害情况分为肾脏损害组20例和无肾脏损害组50例。比较各组临床参数的差异,采用多因素Logistic回归模型分析初诊时伴有胃肠道受累HSP患儿急性期肾脏损害的影响因素。结果胃肠道受累组与无胃肠道受累组在年龄、性别分布、D-D水平、纤维蛋白原水平、IgA、D-D/IgA、白细胞计数、中性粒细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血小板计数、血小板与淋巴细胞比值(PLR)方面比较,差异有统计学意义(P<0.05或P<0.01)。在胃肠道受累组中,有20例患儿发生了急性期肾脏损害,从诊断到出现肾脏损害的中位时间为7 d。肾脏损害组患儿年龄、IgA水平、D-D/IgA低于无肾脏损害组患儿,D-D水平高于无肾脏损害组患儿,差异有统计学意义(P<0.01)。多因素Logistic回归模型结果显示,D-D/IgA(OR=1.999,95%CI:1.245~3.349,P=0.005)是初诊时伴有胃肠道损害的HSP患儿急性期肾脏损害的唯一相关因素。结论初诊时伴有胃肠道受累的HSP患儿中,D-D、IgA和D-D/IgA的水平升高。D-D/IgA是初诊时伴有胃肠道受累的HSP患儿急性期肾脏损害的唯一相关因素。

Objective To investigate the relationships of D-dimer(D-D), immunoglobulin A(IgA) and D-D to IgA ratio(D-D/IgA) with renal impairment in acute phase in Henoch-Sch9 nlein purpura(HSP) children complicated with gastrointestinal involvement at initial diagnosis.Methods A total of 148 children with HSP at initial diagnosis were analyzed retrospectively, and they were divided into no gastrointestinal involvement group with 78 cases and gastrointestinal involvement group with 70 cases according to clinical manifestation.According to condition of renal impairment in acute phase, the children in the gastrointestinal involvement group were divided into renal impairment group with 20 cases and no renal impairment group with 50 cases.The differences of clinical parameters were compared between different groups, and multivariate Logistic regression model was used to analyze the influencing factors of renal impairment in acute phase in HSP children with gastrointestinal involvement at initial diagnosis.Results There were significant differences in age, sex distribution, D-D level, fibrinogen level, IgA, D-D/IgA, leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio(NLR),platelet count, platelet-to-lymphocyte ratio(PLR) between the gastrointestinal involvement group and the no gastrointestinal involvement group(P<0.05 or P<0.01).In the gastrointestinal involvement group, 20 children had renal impairment in acute phase, and the median time from diagnosis to occurrence of renal impairment was 7 days.Age, IgA level and D-D/IgA in the renal impairment group were significantly lower than those in the no renal impairment group, while the D-D level was significantly higher than that in the no renal impairment group(P<0.01).The result of multivariate Logistic regression model showed that D-D/IgA(OR=1.999, 95%CI, 1.245 to 3.349;P=0.005) was the only relevant factor for renal impairment in acute phase in HSP children complicated with gastrointestinal involvement at initial diagnosis.Conclusion The levels of D-D,IgA and D-D/IgA increase in HSP children with gastrointestinal involvement at initial diagnosis.D-D/IgA is the only relevant factor for renal impairment in acute phase in HSP children complicated with gastrointestinal involvement at initial diagnosis.