Clinical Significance Of Serum MIDKINE For Early Diagnosis Of Purpura Nephritis In Children And The Evaluation Of Severity And Prognosis Renal Damage Degree

Objective:Through the detection of Midkine concentration in the serum of Henoch-Schonlein purpura and Henoch-Schonlein purpura nephritis patients,explore its clinical significance in the development of HSP and HSPN.Methods:In the case group,35 cases were hospitalized in the pediatric kidney rheumatism immunology ward of shengjing hospital affiliated to China medical university from December 2016 to January 2018,which met the diagnostic criteria of HSPand HSPN.Among them,10 cases were HSP,25 were HSPN,and 8 cases were reviewed after treatment.In which that control group were the 12 case of a health check for outpatient department in the same period.Collect serum specimens and the corresponding clinical data(including age,gender,24 h urine protein quantitative,blood lipids,blood coagulation function,renal function,part of cases of kidney puncture biopsy results.Measure the concentration of MK in serum.By analyzing the correlation between MK and collection of clinical indicators and pathological types of renal biopsy,this paper provides a clinical basis for early diagnosis of HSPN,and to evaluate the degree of renal damage and long-term prognosis of children with HSPN.Results:There was no statistically significant difference between the case group and the control group(P<0.05).The case group was compared with the healthy control group(289.34 ± 160.70pg/ml VS 100.03 ± 56.75 pg /ml),and the MK concentration was significantly higher than that in the control group(P<0.05).In the case group,the MK concentration of HSPN(nephrotic level proteinuria)was significantly higher than that of HSPN(non-nephrotic level proteinuria)group(449.91 ± 141.91pg/ml VS 244.04 ±89.15pg/ml)(P<0.05).The MK concentration of HSPN(non-nephrotic level proteinuria)was higher than that of HSP group MK :(244.04 ± 89.15pg/ml VS 175.94 ± 46.30pg/ml)(P<0.05).After treatment,the MK concentration was lower than HSPN(non-nephrotic level proteinuria)MK concentration :(186.63 ± 114.40pg/ml VS 244.04 ± 89.15pg/ml).Pearson correlation analysis results show that,in the case group MK and Ig A,Ig E,urine trace albumin,transferrin urine,blood B2 microglobulin,24 hours urinary protein quantitative per weight levels were positively correlated(P < 0.05).The results of ROC subject curve showed that the AUC value of MK prediction was 0.947(95% CI,0.888-1.000),and the optimal value of the diagnosis of HSPN was 218.186pg/ml according to the prediction of the yiden index,and the sensitivity of the diagnosis of purpura nephritis was 84.0% and specificity 95.5%,and the differences among the groups were statistically significant.The AUC value of the MK prediction diagnosis HSP is 0.908(95% CI,0.828-0.988).The optimal value for the predicted diagnosis HSP based on the access index is 182.762pg/ml.The sensitivity is 81.4% and the specificity is 91.7%.The difference between each group is statistically significant.Conclusion:In the case group serum,MK was significantly higher than that in the control group,and the MK concentration of HSPN(nephropathy level proteinuria)was significantly higher than that of HSPN(non-nephrotic level proteinuria).The MK level was significantly reduced after treatment.MK was positively correlated with urinary protein level,which indicate that MK was involved in the development of HSP and HSPN which can provides a basis for early diagnosis of HSP and HSPN and the evaluation of HSPN renal damage degree and long-term prognosis.