| BackgroundHenoch-Sch（?）nlein purpura nephritis（HSPN）is one of the important causes of chronic renal failure in children,which affects the outcome and long-term prognosis of the disease.HSPN and Ig A nephropathy（Ig AN）share similar pathophysiological mechanisms.In Ig AN,Ig A/C3 has certain significance for disease diagnosis,but its role in HSPN is rarely reported.Therefore,this study explored the predictive value of serum Ig A,C3 and Ig A/C3 ratios in children with HSPN and the degree of renal pathological damage,and provided non-invasive,stable and reliable biological indicators for the diagnosis of HSPN.ObjectiveTo explore the predictive value of serum Ig A,C3 and Ig A/C3 ratio in children with HSPN and the degree of renal pathological damage.MethodThe clinical data of children with HSP who were hospitalized in the First Affiliated Hospital of Xinxiang Medical College from July 2018 to December 2020 were retrospectively analyzed.According to whether the kidneys were involved,they were divided into HSP group and HSPN group,and the clinical data of the two groups were compared.The ROC curve was drawn,the area under the curve was calculated,and the sensitivity,specificity and the best predictive cut-off value of serum Ig A,C3 and Ig A/C3ratio for the diagnosis of HSPN were determined.Result1.The total of 85 children in the HSPN group were included,including 51 males（60.0%）and 34 females（40.0%）,and 172 children in the HSP group,including 93 males（54.1%）and 79 females（45.9%）.There was no statistical difference in gender between the two groups（P>0.05）.The median ages of the children in the HSPN group and the children in the HSP group were 10.00（8.00-12.00）years old and 7.00（6.00-9.00）years old,respectively.The median age of the children in the HSPN group was higher than that of the children in the HSP group,and there was a statistical difference.（P<0.05）.There were23 children（27.1%）with gastrointestinal symptoms in the HSPN group,which was significantly lower than 68 children（39.5%）in the HSP group（P<0.05）,and with joint symptoms were 24 cases（28.2%）,49 cases（28.5%）,respectively,there was no statistical difference between the two groups（P>0.05）.Children in the HSPN group and in the HSP group the white blood cell count[8.10（6.55-10.20）×10~9/L vs 9.10（7.30-11.35）×10~9/L],total protein[（65.20±7.80）g/L vs（67.14±5.69）g/L],albumin[41.50（38.65-44.50）g/L vs 43.25（40.42-46.07）g/L],fibrin degradation product[2.50（1.40-5.60）μg/ml vs 4.15（1.97-9.05）μg/ml],D-dimer[0.80（0.50-2.00）μg/ml vs 1.60（0.70-4.22）μg/ml],glomerular filtration rate[154.13（132.82-185.84）ml/min·1.73m~2vs 188.95（166.53-218.84）ml/min·1.73m~2],α1-microglobulin[7.80（3.90-13.86）mg/L vs 4.50（2.25-8.47）mg/L],β2-microglobulin[0.23（0.15-0.35）mg/L vs 0.19（0.13-0.28）mg/L],retinol binding protein[0.15（0.09-0.25）mg/L vs 0.11（0.05-0.18）mg/L],urine microalbumin[124.27（25.29-659.03）mg/L vs 12.84（8.24-18.73）mg/L],urinary transferrin[9.00（3.28-33.30）mg/L vs 0.43（0.20-1.64）mg/L]and urinary immunoglobulin G[13.90（7.34-47.85）mg/L vs 4.97（1.50-8.08）mg/L]were statistically different（P<0.05）.2.The ratios of serum Ig A and Ig A/C3 in the HSPN group were higher than those in the HSP group,and C3 was lower than that in the HSP group,with statistical differences（P<0.05）.3.The ROC curve showed that the sensitivity of serum Ig A in predicting HSPN was75.3%,the specificity was 93.0%,the area under the curve was 0.895,and the best cut-off value was 2.415.The sensitivity of serum C3 in predicting HSPN was 90.6%,the specificity was 26.7%,the area under the curve was 0.589,and the best cut-off value was1.345.The Ig A/C3 ratio predicted HSPN with a sensitivity of 62.9%,a specificity of82.6%,an area under the curve of 0.957,and an optimal cut-off value of 1.843.4.The clinical types of 33 children with HSPN were 1 case of isolated proteinuria,30cases of hematuria and proteinuria,and 2 cases of nephrotic syndrome.The pathological grades were grade I in 5 cases,grade II in 14 cases and grade III cases,but there was no correlation between clinical classification and pathological grade（r=0.109,P=0.544）.5.The levels of serum Ig A,C3 and Ig A/C3 ratio had no significant difference among the pathological grades I,II and III（P>0.05）,and had no correlation with the degree of renal pathological damage（r=-0.237,P=0.85;r=-0.162,P=0.366;r=-0.125,P=0.489）.ConclusionThe more obvious the serum Ig A level and the Ig A/C3 ratio increase,the greater the value of predicting the diagnosis of HSPN.It can be considered as a simple auxiliary diagnostic index in hospitals that perform renal biopsy without conditions,but it cannot replace renal biopsy. |
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