| Objective To investigate the diagnostic value of serum D-dimer,fibrin degradation product(FDP)and serum amyloid A(SAA)tests for abdominal Henoch-Scholein purpura in children.MethodsFrom 2021-09-01 to 2022-12-31,a total of 60 children with Henoch-Scholein purpura(HSP),aged 2-14 years,who were hospitalized in the pediatric ward of Taizhou People’s Hospital were collected,including 25 cases of abdominal HSP group and 35 cases of other types of HSP without gastrointestinal symptoms.Thirty children with abdominal pain as the main symptom(including 15 cases of acute and chronic gastritis,2 cases of acute mesenteric lymphadenitis,8 cases of acute appendicitis,2 cases of chronic appendicitis,1 case of functional abdominal pain,and 2 cases of upper respiratory tract infection(gastrointestinal type))admitted during the same period were selected as the abdominal pain group;30 cases of healthy children who were examined by the Department of Pediatrics or the Department of Endocrinology were selected as the control group.General data of children in each group were collected,such as gender,age,white blood cell count,absolute neutrophil count,absolute lymphocyte count,platelet count,CRP and imaging data.The levels of serum D-dimer,FDP and SAA were measured by ELISA in each group of children,and the differences in the levels of the three were observed between the groups to evaluate the value of their combined testing for the diagnosis of abdominal HSP.Results1.Comparison of general data: There were no statistically significant differences in gender and age between the abdominal HSP group,other types of HSP group,abdominal pain group and control group(P>0.05).The white blood cell counts in the abdominal HSP group were higher than those in the other HSP groups and the abdominal pain group,and the differences were statistically significant(P < 0.05);the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)levels in the abdominal HSP group were higher than those in the other HSP groups,and the differences were statistically significant(P < 0.05);the platelet counts in the abdominal HSP group were higher than those in the abdominal pain group,and the differences were statistically significant(P < 0.05).There was no significant difference in the absolute neutrophil count,absolute lymphocyte count and CRP between the abdominal HSP group,other types of HSP groups and abdominal pain group(P > 0.05).The white blood cell count,absolute neutrophil count,platelet count,NLR,PLR and CRP were higher in the abdominal HSP group than in the control group,and the differences were statistically significant(P < 0.05).2.In the abdominal HSP group,10 children had abdominal ultrasound examination,4 cases showed enlarged abdominal lymph nodes(16%),3 cases showed echogenicity of the abdominal intestinal canal wall and fluid in the abdominal cavity(12%);13 cases had abdominal CT examination,10 cases showed thickened edema of part of the small intestinal canal wall,multiple lymph nodes in the retroperitoneum of the abdominal cavity,dilated gas and fluid in part of the abdominal pelvic canal and fluid in the pelvic cavity(40%),3 cases showed more intestinal canal contents and no obvious leakage.In seven cases,gastroscopy was performed,and three cases showed erosive gastritis and multiple small intestine erosions(12%);four cases showed colitis and superficial gastritis(16%).The imaging manifestations were more severe in children with abdominal HSP than in the group with other types of HSP and abdominal pain.3.D-dimer levels in children with abdominal HSP were higher than those in the other types of HSP group and the control group [(5.99±4.87)vs(3.68±5.18)] and [(5.99±4.87)vs(0.64±0.29)],with statistically significant differences(P<0.01,P<0.0001);D-dimer levels in children with abdominal HSP were higher than those in the abdominal pain group [(5.99± 4.87)vs(2.41±2.17)],and the difference was statistically significant(P<0.001).4.The level of FDP in children with abdominal HSP was higher than that in the other types of HSP group and the control group [(5.44±2.99)vs(3.12±2.83)],[(5.44±2.99)vs(0.79±0.59)],and the difference was statistically significant(P < 0.01,P<0.0001);the level of FDP in children with abdominal HSP was higher than that in the abdominal pain group [(5.44±2.99)vs(2.77±2.49)],and the difference was statistically significant(P<0.001).5.The SAA levels of children with abdominal HSP were higher than those of the other types of HSP group and the control group [(22.54±10.08)vs(16.06±8.24)] and[(22.54±10.08)vs(4.73±2.57)],with statistically significant differences(P<0.01,P<0.0001);the SAA levels of children with abdominal HSP were higher than those of the abdominal pain group [(22.54± 10.08)vs(13.92±7.66)],with statistically significant differences(P<0.001).6.The area under the curve(AUC)of serum D-dimer,FDP and SAA for detecting abdominal HSP alone were 0.742,0.738 and 0.718 respectively.The sensitivity and specificity of D-dimer in the diagnosis of abdominal HSP were 96% and 49% respectively;The sensitivity and specificity of FDP in diagnosing abdominal HSP were88% and 52% respectively;The sensitivity and specificity of SAA in diagnosing abdominal HSP were 76% and 63% respectively.The AUC of the three combined tests was 0.813,significantly higher than that of the three alone(P<0.05),with a sensitivity of 92% and a specificity of 65%.Conclusion(1)The levels of serum D-dimer,FDP and SAA in children with abdominal HSP were significantly higher than those in the other types of HSP and abdominal pain groups,suggesting that the inflammatory reaction and endothelial damage in children with abdominal HSP were more severe,and the coagulation and fibrinolytic systems of the body were more hyperfunctional;(2)Serum D-dimer,FDP and SAA expression levels were elevated in children with abdominal HSP,and the diagnostic value of the combined test was better than that of the individual tests,suggesting that the combined test has higher diagnostic efficacy for abdominal HSP. |
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