D-D、FIB、IL-18、IGF-1与儿童过敏性紫癜患者预后的相关分析

Correlation between D-D,FIB,IL-18,IGF-1 with prognosis in children with Henoch-Schonlein purpura

目的 探讨D-二聚体(D-D)、纤维蛋白原(FIB)、白介素-18(IL-18)、胰岛素样生长因子-1(IGF-1)与儿童过敏性紫癜(HSP)患者预后的相关性。方法 选取2020年10月至2021年10于本院接受诊治且随访至2022年4月的96例HSP患儿作为研究对象,均予以甲泼尼龙治疗治疗,观察疗效,比较治疗前后的血清D-二聚体(D-D)、纤维蛋白原(FIB)、白介素18(IL-18)、胰岛素样生长因子-1(IGF-1)水平;并根据治疗后6个月内有无复发或并发紫癜性肾炎分为预后不良组(n=28)与预后良好组(n=68),对比D-D、FIB、IL-18、IGF-1不同水平的复发率、紫癜性肾炎发生率,采用二元Logistic回归模型分析D-D、FIB、IL-18、IGF-1对HSP患儿预后影响;采用ROC曲线分析D-D、FIB、IL-18、IGF-1的预测效能。结果 96例HSP患儿的总有效率81.26%,且治疗后D-D、FIB、IL-18、IGF-1水平低于治疗前(P<0.05)。随访6个月,紫癜性肾炎发生率13.54%、复发率15.63%。预后不良组治疗前、治疗后D-D、FIB、IL-18、IGF-1高于预后良好组(P<0.05)。血清D-D、FIB、IL-18、IGF-1高表达组的复发率、紫癜性肾炎发生率高于低表达组(P<0.05)。Logistic回归模型中分析显示,D-D、FIB、IL-18、IGF-1高表达是影响HSP患儿预后的危险因素(P<0.05)。ROC曲线分析显示,血清D-D、FIB、IL-18、IGF-1预测HSP患儿预后不良的AUC值分别为(0.830、0.614、0.793、0.695,P<0.05)。结论 综上所述,血清D-D、FIB、IL-18、IGF-1会随着HSP患儿再次复发和并发紫癜性肾炎而升高,动态监测其水平变化能为预后评估提供重要参考。

Objective To investigate the correlations between D-dimer(D-D),fibrinogen(FIB),interleukin-18(IL-18),insulin-like growth factor-1(IGF-1)with prognosis in children with Henoch-Schonlein purpura(HSP).Methods We conducted a followed-up in HSP children(n=96)who visited our hospital(October 2020-October 2021)until April 2022,the patients were managed by methylprednisolone,the curative effect was observed,and the serum levels of D-D,FIB,IL-18,IGF-1 were compared before and after treatment.They were allocated to poor prognosis group(n=28)and good prognosis group(n=68)according to whether presence or absence of recurrent purpura nephritis within 6 months after treatment.The recurrence rate and the incidence of purpuric nephritis were compared.The correlations between D-D,FIB,IL-18,IGF-1 with prognosis in HSP children was assessed by binary Logistic regression.The predictive performance of D-D,FIB,IL-18 and IGF-1 was analyzed by receiver operating characteristic(ROC)curve.Results After treatment,the total effective rate of 96 HSP children was 81.26%,and the levels of D-D,FIB,IL-18 and IGF-1 were lower as compared to before treatment(P<0.05).During the 6-month follow-up,the incidence and the recurrence rate of purpuric nephritis was 13.54%and 15.63%,respectively.The D-D,FIB,IL-18 and IGF-1 in the poor prognosis group were higher than those in the good prognosis group irrespective of before and after treatment(P<0.05).The recurrence rate and incidence of purpura nephritis in the high expression group of serum D-D,FIB,IL-18 and IGF-1 were higher than those in the low expression group(P<0.05).Logistic regression model analysis showed that high expression of D-D,FIB,IL-18 and IGF-1 were risk factors affecting the prognosis of HSP children(P<0.05).ROC curve analysis showed that the area under the curve(AUC)values of serum D-D,FIB,IL-18,and IGF-1 for predicting poor prognosis in HSP children were 0.830,0.614,0.793,0.695,respectively(P<0.05).Conclusion In conclusion,serum D-D,FIB,IL-18,IGF-1 are positively correlated with recurrent purpura nephritis in HSP children,Dynamic monitoring of their level changes can provide an important reference for prognosis evaluation.