血清IgE和NGAL在小儿肾病综合征激素耐药评估中的应用价值

Application value of serum IgE and NGAL in the evaluation of steroid resistance in children with nephrotic syndrome

目的研究血清免疫球蛋白E(IgE)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在小儿肾病综合征(NS)激素耐药评估中的应用价值。方法选取西安市儿童医院2017年4月至2021年3月收治的180例NS患儿作为研究对象,根据患儿治疗4周后尿蛋白是否转阴将其分为耐药组(35例)和敏感组(145例)。纳入同期入院体检的60例健康小儿作为对照组。比较三组的血清IgE和NGAL水平;使用受试者工作特征(ROC)曲线分析IgE和NGAL对NS患儿激素耐药的预测价值;使用二元Logistic回归分析IgE、NGAL阳性与NS患儿激素耐药的相关性。结果对照组的IgE和NGAL水平均明显低于耐药组和敏感组,差异具有统计学意义(P<0.05)。耐药组的IgE水平明显低于敏感组,NGAL水平明显高于敏感组,差异具有统计学意义(P<0.05)。IgE预测NS患儿激素耐药的曲线下面积(AUC)为0.879(95%CI 0.816~0.941),灵敏度为80.00%,特异度为85.52%;NGAL预测NS患儿激素耐药的AUC为0.854(95%CI 0.795~0.914),灵敏度为82.86%,特异度为77.24%。IgE阳性和NGAL阳性均为NS患儿激素耐药发生的独立危险因素(P<0.05)。结论血清IgE和NGAL对NS患儿激素耐药的预测价值良好,且均为NS患儿激素耐药发生的独立危险因素。

Objective To study the application value of serum immunoglobulin E(IgE)and neutrophil gelatinase-associated lipocalin(NGAL)in the evaluation of steroid resistance in children with nephrotic syndrome(NS).Methods A total of 180 children with NS admitted in Xi'an Children's Hospital from April 2017 to March 2021 were selected as the research objects,and the children were divided into drug resistance group(35 cases)and sensitive group(145 cases)according to whether the urine protein turned neqative after 4 weeks of treatment.Sixty healthy children admitted in hospital for physical examination at the same period were selected as control group.Serum IgE and NGAL levels were compared among the three groups.The predictive value of IgE and NGAL for steroid resistance in children with NS was analyzed by receiver operating characteristic(ROC)curve.Binary Logistic regression analysis was used to analyze the correlation between IgE,NGAL and steroid resistance in children with NS.Results The levels of IgE and NGAL in the control group were significantly lower than those in the drug resistance group and the sensitive group,and the differences were statistically significant(P<0.05).The IgE level of the drug resistance group was significantly lower than that of the sensitive group,and the level of NGAL was significantly higher than that of the sensitive group,and the differences were statistically significant(P<0.05).The area under curve(AUC)of IgE in predicting steroid resistance in children with NS was 0.879(95%CI 0.816-0.941),the sensitivity was 80.00%,and the specificity was 85.52%;the AUC of NGAL in predicting steroid resistance in children with NS was 0.854(95%CI 0.795-0.914),the sensitivity was 82.86%,and the specificity was 77.24%.IgE positive and NGAL positive were independent risk factors for steroid resistance in children with NS(P<0.05).Conclusion Serum IgE and NGAL have good predictive value for steroid resistance in children with NS,and they are independent risk factors for the development of steroid resistance in children with NS.