中性粒细胞胞外诱捕网在儿童IgA血管炎中的表达及临床意义

The Involvement of Neutrophil Extracellular Trapping Nets in Children with IgA Vasculitis

目的探讨中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs)在IgA血管炎(IgA vasculitis,IgAV)儿童外周血中的表达及意义。方法选取2021年6月~2022年7月在徐州医科大学附属医院儿科初诊收治的101例IgAV患儿,根据肾脏受累情况将患儿分为无肾脏受累组54例、合并肾脏累及组47例(包括孤立性血尿组15例、孤立性蛋白尿组16例、血尿合并蛋白尿组16例),另选取同时段健康体检儿童30例作为对照组;测定血清NETs标志物髓过氧化物酶(myeloperoxidase,MPO)-DNA含量,比较各组外周血MPO-DNA水平,并与临床和实验室指标行相关性分析。结果无肾脏受累组及肾脏累及组患儿的血清MPO-DNA水平高于对照组,3组比较差异均有统计学意义(P均<0.05)。血尿和蛋白尿组血清MPO-DNA水平明显高于孤立性血尿组及单纯蛋白尿组,差异均有统计学意义(P均<0.05)。相关性分析显示,IgAV患儿血清MPO-DNA水平与C-反应蛋白(C-reactive protein,CRP)、血清IgA浓度、D-二聚体水平、尿白蛋白肌酐比值(urinary albumin creatinine ratio,UACR)之间均呈线性正相关。结论NETs参与IgAV患儿疾病发生、表达水平与其肾脏损害有关。

Objective To investigate the expression and significance of neutrophil extracellular traps(NETs)in the peripheral blood of children with IgA vasculitis(IgAV).Methods From June 2021 to July 2022,101 children with IgAV who were admitted to the Department of Pediatrics of the Affiliated Hospital of Xuzhou Medical University were selected and divided into two groups according to the renal involvement:54 cases in the group without renal involvement,and 47 cases in the group with combined renal involvement(including 15 cases in the group with isolated hematuria,16 cases in the group with isolated proteinuria,and 16 cases in the group with hematuria combined with proteinuria);and 30 children with healthy physical examination at the same time were selected as the control group.The levels of myeloperoxidase(MPO)-DNA,a marker of NETs,were measured,and the peripheral blood MPO-DNA levels were compared among the groups,and correlation analysis was performed with clinical and laboratory indices.Results The serum MPO-DNA levels of children in the no kidney involvement group and the kidney involvement group were higher than those in the control group,and the differences between the three groups were statistically significant(P<0.05).The serum MPO-DNA levels in the hematuria and proteinuria groups were significantly higher than those in the isolated hematuria and proteinuria groups,and the differences were statistically significant(P<0.05).The correlation analysis showed that the serum MPO-DNA levels of children with IgAV were positively correlated with C-reactive protein(CRP),serum IgA concentration,D-dimer level,and urinary albumin creatinine ratio(UACR).Conclusion NETs are involved in disease development in children with IgAV;the expression levels are associated with their renal damage.