贾丽丹,张涛,饶静,周燕,杨彬,张力
JIA Lidan,ZHANG Tao,RAO Jing,ZHOU Yan,YANG Bin,ZHANG Li

• 1:贵州医科大学临床医学院
• 2:贵州医科大学
• 3:贵州医科大学附属医院儿科肾脏风湿免疫科

摘要(Abstract)：

目的 探讨血红细胞分布宽度(RDW)、中性粒细胞与淋巴细胞比值(NLR)在预测儿童紫癜性肾炎(HSPN)及新月体形成中诊断价值。方法 选取确诊为过敏性紫癜(HSP)患者为研究对象，收集患儿血常规、血生化及肾脏病理检查结果，根据有无肾脏损害分为HSPN组和非HSPN组，HSPN组依据肾脏病理检查有无新月体形成分为有新月体组和无新月体组；对各分组临床资料进行非参数检验，采用二元logistic回归分析RDW、NLR是否HSPN及新月体形成的影响因素，受试者特征工作曲线(ROC)下面积(AUC)分析RDW、NLR对HSPN新月体形成的诊断价值，Spearman分析RDW、NLR与C-反应蛋白(CRP)、24 h尿蛋白定量(24-UP)相关性。结果 HSPN组患儿的年龄、血红蛋白(HGB)、血小板(PLT)、尿素氮(BUN)、肌酐(SCR)、胱抑素-C(Csy-C)、免疫球蛋白-A(IgA)、24-UP、RDW及NLR的水平高于非HSPN组，CRP、白蛋白(ALB)、免疫球蛋白-G(IgG)水平低于非HSPN组(P<0.05),有新月体组患儿的白细胞(WBC)、PLT、IgA、RDW、NLR高于无新月体组(P<0.05);二元logistic回归分析显示，RDW、NLR是HSP患儿发生HSPN的影响因素，RDW是HSPN新月体形成的影响因素；RDW、NLR诊断HSPN发生的AUC值分别为0.652,0.546,两者联合诊断HSPN发生的AUC值为0.665;RDW、NLR诊断新月体形成的AUC值分别为0.653,0.648,两者联合诊断新月体形成的AUC值为0.654;RDW、NLR与24-UP呈正相关；CRP与RDW呈负相关，与NLR无相关性。结论 RDW、NLR是发生HSPN的影响因素，RDW是HSPN新月体形成的影响因素；RDW、NLR联合诊断HSPN的发生及其新月体形成的价值较单一指标意义更大。
Objective To explore the diagnostic value of red blood cell distribution width(RDW) and neutrophil to lymphocyte ratio(NLR) in predicting the occurrence and crescent formation of Henoch-Schonlein purpura nephritis(HSPN) of children. Methods Patients with henoch-sch9nlein purpura(HSP) as research objects were selected and divided into HSPN group and non HSPN group based on the presence of renal damage. The blood routine, blood biochemistry, and renal pathological examination results of the patients were collected. The HSPN group was divided into the crescent group and non-crescent group based on the presence of crescent body components in the renal pathological examination. Non parametric tests on clinical data from each group were performed, and binary logistic regression was applied to confirm whether RDW and NLR were HSPN and the diagnostic value of RDW and NLR in the formation of HSPN crescents. was analyzed. The area under the receiver operating curve(AUC) was analyzed, and the correlation between RDW, NLR, C-reactive protein(CRP), and 24-hour urine protein quantification(24-UP) was analyzed with Spearman. Results The age, hemoglobin, platelets, blood urea, blood creatinine, cystatin-C, immunoglobulin-A, 24-hour urine protein quantification, RDW, NLR levels in the purpura nephritis group were higher than those in the non purpura nephritis group, while C-reactive protein, albumin, and immunoglobulin-G levels were lower than those in the non-purpura nephritis group(P<0.05). The white blood cells, platelets, immunoglobulin-A, RDW, and NLR in the crescent group were higher than those in the non-crescent group(P<0.05). Binary logistic regression analysis shows that RDW and NLR were the influencing factors for the occurrence of HSPN, while RDW was the influencing factor for the formation of HSPN crescents. The AUC values of RDW and NLR in diagnosing HSPN were 0.652 and 0.546, respectively. The AUC value of the combination of the two in diagnosing HSPN was 0.665; The AUC values for diagnosing crescent formation in RDW and NLR were 0.653 and 0.648, respectively. The AUC value for diagnosing crescent formation in combination of the two was 0.654. RDW and NLR were positively correlated with 24-hour urine protein quantification; C-reactive protein is negatively correlated with RDW, but not significantly correlated with NLR. Conclusion RDW and NLR are the influencing factors for the occurrence of HSPN, while RDW is the influencing factor for the formation of HSPN crescents. The value of combining RDW and NLR in the diagnosis of crescent occurrence and formation of purpura nephritis is greater than that of a single indicator.

关键词(KeyWords)： 红细胞分布宽度;中性粒细胞与淋巴细胞比值;紫癜性肾炎;新月体;影响因素;诊断价值
red blood cell distribution width;neutrophil to lymphocyte ratio;henoch-sch9nlein purpura nephritis;crescent;influence factor;diagnostic value

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技计划项目(黔科合平台人才[2019]5406);; 贵州省卫生健康委科学技术基金(gzwjkj2019-1-002)

作者(Author): 贾丽丹,张涛,饶静,周燕,杨彬,张力
JIA Lidan,ZHANG Tao,RAO Jing,ZHOU Yan,YANG Bin,ZHANG Li

DOI: 10.19367/j.cnki.2096-8388.2023.07.010

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