全身免疫炎症指数和红细胞分布宽度在儿童过敏性紫癜合并肾损害中的变化及意义

Changes and significance of systemic immune-inflammation index and red blood cell distribution width in children with Henoch-Schonlein purpura complicated with renal damage

目的探讨全身免疫炎症指数(SII)和红细胞分布宽度(RDW)在预测儿童过敏性紫癜(HSP)合并肾损害中的临床价值。方法选取2018年6月至2022年12月在南京医科大学附属淮安第一医院住院治疗的191例HSP患儿为研究对象,其中77例为肾损害组,114例为无肾损害组。分析两组患儿的一般资料和实验室检查结果,通过多因素Logistic回归分析HSP合并肾损害的危险因素;以Spearman相关性分析SII和RDW与24小时尿蛋白定量(24h-UPRO)之间的相关性;利用受试者工作特征(ROC)曲线评估SII和RDW对HSP合并肾损害的预测价值。结果两组患儿的年龄(t=-2.449)、白细胞计数(t=-3.057)、血红蛋白(t=-2.304)、红细胞压积(t=-2.630)、RDW(t=-8.617)、中性粒细胞计数(t=-2.788)、中性粒细胞/淋巴细胞比值(Z=-2.887)、SII(Z=-3.325)比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,RDW(OR=1.861,95%CI:1.526~2.270,P<0.001)、SII(OR=1.003,95%CI:1.001~1.005,P=0.008)均是HSP患儿发生肾损害的独立危险因素。RDW、SII水平与24h-UPRO水平均呈正相关(r值分别为0.256、0.429,P<0.05)。ROC曲线评估显示,RDW预测HSP患儿合并肾损害的曲线下面积(AUC)为0.817(95%CI:0.757~0.877,P<0.001),最佳截断值为38.85fL,灵敏度和特异度分别为80.52%和70.18%;SII预测HSP患儿合并肾损害的AUC为0.642(95%CI:0.562~0.721,P=0.001),最佳截断值为401.67×10^(9)/L,灵敏度和特异度分别为81.82%和43.86%;二者联合预测HSP患儿合并肾损害的AUC为0.845(95%CI:0.790~0.900,P<0.001),灵敏度和特异度分别为87.01%和71.93%。结论SII和RDW对预测HSP患儿合并肾损害有一定的临床应用价值。

Objective To explore the clinical value of the systemic immune-inflammation index(SII)and red blood cell distribution width(RDW)in predicting renal damage in children with Henoch-Schonlein purpura(HSP).Methods A total of 191 children with HSP who were hospitalized at Huai′an First People's Hospital affiliated to Nanjing Medical University from June 2018 to December 2022 were selected as the study objects.Among them,77 cases were in the renal damage group,and 114 cases were in the non-renal damage group.The general data and laboratory results of the two groups were analyzed.Multivariate Logistic regression analysis was used to identify risk factors for HSP complicated by renal damage.The correlation between SII and RDW with 24-hour urine protein(24h-UPRO)was analyzed using Spearman correlation analysis.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of SII and RDW for HSP complicated by renal damage.Results There were statistically significant differences between the two groups of children in terms of age(t=-2.449),white blood cell count(t=-3.057),hemoglobin(t=-2.304),hematocrit(t=-2.630),RDW(t=-8.617),neutrophil count(t=-2.788),neutrophil/lymphocyte ratio(Z=-2.887),and SII(Z=-3.325)(P<0.05).Multivariate Logistic regression analysis showed that RDW(OR=1.861,95%CI:1.526-2.270,P<0.001)and SII(OR=1.003,95%CI:1.001-1.005,P=0.008)were independent risk factors for renal damage in children with HSP.RDW and SII levels were positively correlated with 24h-UPRO levels(r=0.256 and 0.429,respectively,P<0.05).ROC curve evaluation showed that the area under the curve(AUC)of RDW in predicting renal damage in children with HSP was 0.817(95%CI:0.757-0.877,P<0.001),with an optimal cutoff value of 38.85fL,and the sensitivity and specificity were 80.52%and 70.18%respectively.The AUC of SII in predicting renal damage in children with HSP was 0.642(95%CI:0.562-0.721,P=0.001),with an optimal cutoff value of 401.67×10^(9)/L,and the sensitivity and specificity were 81.82%and 43.86%respectively.When combined,the AUC for predicting renal damage in children with HSP was 0.845(95%CI:0.790-0.900,P<0.001),and the sensitivity and specificity were 87.01%and 71.93%respectively.Conclusion SII and RDW have certain clinical application value in predicting renal damage in children with HSP.