血清sST2、IGF-1在过敏性紫癜患儿中的临床意义及其预测合并肾损伤的预后价值

Clinical significance of serum sST2 and IGF-1 in children with allergic purpura and their prognostic value in predicting concurrent kidney injury

目的探讨血清可溶性人基质裂解素(sST2)、胰岛素样生长因子-1(IGF-1)在过敏性紫癜患儿中的临床意义及其预测合并肾损伤的预后价值。方法回顾性选择2019年1月至2022年6月渭南市妇幼保健院诊治的过敏性紫癜患儿100例为研究对象,根据患儿是否出现肾损害,将单纯过敏性紫癜患儿作为单纯紫癜组(n=69),过敏性紫癜合并肾损伤患儿作为合并肾损害组(n=31),并选择同期在渭南市妇幼保健院体检的儿童30名作为对照组。分析单纯紫癜组、合并肾损害组患儿与对照组儿童的血清sST2、IGF-1水平;分析影响过敏性紫癜患儿肾损害的单因素,采用多因素Logistic回归分析法分析过敏性紫癜患儿出现肾损伤的危险因素。随访6个月,根据过敏性紫癜合并肾损伤患儿的预后结果,将合并肾损害组患儿分为预后良好组和预后不良组,比较两组血清sST2、IGF-1水平差异。通过受试者工作特征(ROC)曲线下面积(AUC)评价血清sST2、IGF-1联合诊断对过敏性紫癜患儿预后不良的预测效能。结果单纯紫癜组血清sST2、IGF-1水平分别为(1865.52±358.77)pg/mL、(0.65±0.11)ng/L,均高于对照组[(1043.31±245.89)pg/mL、(0.30±0.07)ng/L],合并肾损害组血清sST2、IGF-1水平分别为(2056.74±421.25)pg/mL、(0.95±0.18)ng/L,均高于对照组和单纯紫癜组,差异均有统计学意义(P<0.05)。单因素分析结果显示,合并肾损害组与单纯紫癜组患儿的嗜酸性粒细胞数(EOS)、血小板计数(PLT)、白细胞计数(WBC)水平、皮疹是否发生、反复呼吸道感染、血清sST2、IGF-1水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,EOS>0.7×10^(9)/L、PLT>300×10^(9)/L、WBC>12×10^(9)/L、皮疹反复发作、反复呼吸道感染、血清sST2水平升高、血清IGF-1水平升高是过敏性紫癜患儿出现肾损伤的危险因素(P<0.05)。平均随访(4.62±1.35)个月,31例过敏性紫癜合并肾损害患儿中,预后良好组21例,预后不良组10例。预后不良组患儿的血清sST2、IGF-1水平分别为(2105.23±415.23)pg/mL、(1.15±0.18)ng/L,均明显高于预后良好组[(1252.45±312.50)pg/mL、(0.52±0.11)ng/L],差异均有统计学意义(P<0.05)。联合诊断的灵敏度为90.0%,特异度为81.0%,AUC为0.976,血清sST2 AUC为0.910,IGF-1 AUC为0.837,联合诊断AUC大于单一指标血清sST2、IGF-1,差异均有统计学意义(P<0.05)。结论过敏性紫癜患儿血清sST2、IGF-1水平升高,二者水平升高会增加肾损害的发生率,二则联合检测可预测过敏性紫癜患儿合并肾损害的预后效果,效能高于单一检测。

Objective To explore the clinical significance of serum soluble human matrix lysin(sST2)and insulin-like growth factor-1(IGF-1)in children with allergic purpura and their prognostic value in predicting concurrent kidney injury.Methods One hundred cases of children with allergic purpura diagnosed and treated in Weinan Maternal and Child Health Hospital from January 2019 to June 2022 were retrospectively selected as the research objects.According to whether the children showed renal damage or not,children with simple allergic purpura were selected as the simple purpura group(n=69),and children with allergic purpura combined with kidney damage were selected as the combined kidney damage group(n=31).Thirty children who came to Weinan Maternal and Child Health Hospital for physical examination during the same period were selected as the control group.The levels of serum sST2 and IGF-1 were analyzed in children with simple purpura group,combined with renal damage group,and control group.The single factor affecting renal damage in children with allergic purpura was analyzed,and the multiple Logistic regression analysis was used to analyze the risk factors for renal damage in children with allergic purpura.Followed up for 6 months,and the children in the simple purpura group were divided into good prognosis group and bad prognosis group according to the prognosis of children with anaphylactoid purpura complicated with kidney damage and the serum levels of sST2 and IGF-1 were compared between the two groups.The predictive efficacy of the combination of serum sST2 and IGF-1 diagnosis on the outcome of children with allergic purpura was evaluated by the receiver operator characteristic(ROC)area under the curve(AUC).Results The levels of serum sST2 and IGF-1 in the simple purpura group were(1865.52±358.77)pg/mL and(0.65±0.11)ng/L,respectively,which were higher than those in the control group[(1043.31±245.89)pg/mL and(0.30±0.07)ng/L],the levels of serum sST2 and IGF-1 in the combined renal injury group were(2056.74±421.25)pg/mL and(0.95±0.18)ng/L,respectively,which were higher than those in the control group and the simple purpura group,and the differences were statistically significant(P<0.05).Univariate analysis showed that there were statistically significant differences(P<0.05)in eosinophil count(EOS),platelet count(PLT),white blood cell count(WBC),rash occurrence,recurrent respiratory infections,serum sST2,and IGF-1 levels between the combined kidney damage group and the sinple purpura group.Multiple Logistic regression analysis showed that EOS>0.7×10^(9)/L,PLT>300×10^(9)/L,WBC>12×10^(9)/L,recurrent rash attacks,recurrent respiratory infections,elevated serum sST2 levels,and elevated serum IGF-1 levels were risk factors for renal injury in children with allergic purpura.On average follow-up(4.62±1.35)months,among 31 children with allergic purpura complicated with renal damage,21 had a good prognosis and 10 had a poor prognosis.The serum levels of sST2 and IGF-1 in children with poor prognosis group were(2105.23±415.23)pg/mL,(1.15±0.18)ng/L,which were significantly higher than those with good prognosis group[(1252.45±312.50)pg/mL,(0.52±0.11)ng/L],and the differences were statistically significant(P<0.05).The ROC curve results showed that the sensitivity of the combined diagnosis was 90.0%,the specificity was 81.0%,and the AUC was 0.976,which was greater than the 0.910 of the single indicator serum sST2 and 0.837 of serum IGF-1,the differences were statistically significant(P<0.05).Conclusion Serum levels of sST_(2) and IGF-1 will increase in children with allergic purpura,both of which will increase the incidence of renal impairment,which is closely related to the prognosis of children with renal impairment.