ASO阳性HSPN患儿NLR、PLR、MPR和免疫球蛋白检测的临床价值

doi:10.3969/j.issn.1673-8640.2023.06.016

摘要/Abstract

摘要：

目的探讨中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、平均血小板体积/血小板比值（MPR）和免疫球蛋白在抗链球菌溶血素O（ASO）阳性过敏性紫癜性肾炎（HSPN）患儿中的临床价值。方法选取2020年1月—2021年1月湖南省儿童医院收治的110例过敏性紫癜（HSP）患儿。根据抗链球菌溶血素O（ASO）是否阳性分为ASO组（46例）和未感染组（64例）。根据有无肾脏病变将ASO组细分为ASO-HSPN组（28例）和ASO-HSP组（18例）。以同期湖南省儿童医院体检健康儿童98名作为正常对照组。检测所有研究对象的血常规和IgA、IgG、IgM水平，计算NLR、PLR、MPR。采用二元Logistic回归分析评估ASO阳性HSP患儿发生HSPN的危险因素。采用受试者工作特征（ROC）曲线评价各项指标诊断ASO阳性HSPN的价值。结果 ASO组、未感染组IgA、IgG、IgM、NLR均显著高于正常对照组（P<0.001）。未感染组MPR、PLR与正常对照组比较，差异有统计学意义（P<0.01）。与未感染组比较，ASO组IgA、IgG、IgM升高（P<0.05）。ASO组累及关节、肾脏的比例稍高于未感染组，但差异无统计学意义（P>0.05）。ASO-HSPN组MPR高于ASO-HSP组（P=0.002），其他指标2个组之间差异均无统计学意义（P>0.05）。二元Logistic回归分析结果显示，MPR是ASO阳性HSP患儿发生HSPN的危险因素[比值比（OR）值=3.142，95%可信区间（CI）为1.414~8.657，P=0.027]。ROC曲线分析结果显示，MPR诊断ASO阳性HSPN的曲线下面积为0.780，最佳临界值为0.032，敏感性为64.3%，特异性为88.9%。结论 HSP合并链球菌感染会导致患儿更严重的体液免疫功能紊乱，MPR在ASO阳性HSPN的辅助诊断中有一定的价值。

关键词: 中性粒细胞/淋巴细胞比值, 血小板/淋巴细胞比值, 平均血小板体积/血小板比值, 免疫球蛋白, 过敏性紫癜, 过敏性紫癜性肾炎

Abstract:

Objective To investigate the clinical roles of neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR），mean platelet volume-to-platelet ratio（MPR） and immunoglobulins in children with anti-streptolysin O（ASO）-positive Henoch-Sch?nlein purpura nephritis（HSPN）. Methods Totally，110 children with Henoch-Sch?nlein purpura（HSP） were enrolled from Hunan Children's Hospital from January 2020 to January 2021 and classified into ASO group（46 cases） and uninfected group（64 cases） according to whether they were positive for ASO，and the ASO group was further classified into ASO-HSPN group（28 cases） and ASO-HSP group（18 cases） according to the presence or absence of renal lesions. Totally，98 healthy children from Hunan Children's Hospital were enrolled as healthy control group. Blood routine test was performed，IgA，IgG and IgM levels were determined，and NLR，PLR and MPR were calculated. Binary Logistic regression analysis was used to assess the risk factors for the development of HSPN in children with ASO-positive HSP. Receiver operating characteristic（ROC） curve was used to evaluate the value of each index for the diagnosis of ASO-positive HSPN. Results IgA，IgG，IgM and NLR in ASO group and uninfected group were higher than those in healthy control group（P<0.001）. There was statistical significance for MPR and PLR between uninfected group and healthy control group（P<0.01）. Compared with uninfected group，IgA，IgG and IgM in ASO group were increased（P<0.05）. The proportion of joint and kidney involvement in ASO group was slightly higher than that in uninfected group（P>0.05）. MPR in ASO-HSPN group was higher than that in ASO-HSP group（P=0.002），and the differences in the other indicators were not statistically significant between the 2 groups（P>0.05）. Binary Logistic regression analysis showed that MPR was a risk factor for the development of HSPN in children with ASO-positive HSP [odds ratio（OR）= 3.142，95% confidence interval（CI） 1.414-8.657，P=0.027]. The results of ROC curve analysis showed that the area under curve of MPR for the diagnosis of ASO-positive HSPN was 0.780，with an optimal cut-off value of 0.032. The sensitivity was 64.3%，and the specificity was 88.9%. Conclusions HSP combined with streptococcal infection can lead to severe humoral immune dysfunction. MPR has some value in the ancillary diagnosis of ASO-positive HSPN.

Key words: Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Mean platelet volume-to-platelet ratio, Immunoglobulin, Henoch-Sch?nlein purpura, Henoch-Sch?nlein purpura nephritis

中图分类号:

R446.1

刘灿, 罗伶俐, 付敏. ASO阳性HSPN患儿NLR、PLR、MPR和免疫球蛋白检测的临床价值[J]. 检验医学, 2023, 38(6): 590-593.

LIU Can, LUO Lingli, FU Min. Clinical roles of NLR，PLR，MPR and immunoglobulin determination in ASO-positive HSPN children[J]. Laboratory Medicine, 2023, 38(6): 590-593.

图/表 3

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组别	例数	IgA/（g/L）	IgG/（g/L）	IgM/（g/L）	NLR
ASO组	46	2.84±1.00^**#	11.52±3.09^**###	1.27±0.49^**##	3.06±2.00^**
未感染组	64	2.39±0.82^**	8.77±2.74^**	1.03±0.43^**	3.94±3.61^**
正常对照组	98	0.88±0.23	8.01±1.35	0.76±0.12	1.27±0.64
统计值		8.341	5.007	1.767	67.574
P值		<0.001	<0.001	<0.001	<0.001
组别	PLR	MPR	累及器官
组别	PLR	MPR	关节/[例（%）]	胃肠道/[例（%）]	肾脏/[例（%）]
ASO组	128.34±46.44	0.032±0.010	28（60.87）	22（47.83）	28（60.87）
未感染组	168.75±89.26^**	0.029±0.008^*	32（50.00）	39（60.94）	37（57.81）
正常对照组	113.07±27.81	0.030±0.010
统计值	13.648	11.219	1.275	2.523	0.103
P值	0.001	0.004	0.259	0.112	0.748

组别	例数	IgA/（g/L）	IgG/（g/L）	IgM/（g/L）	NLR
ASO组	46	2.84±1.00^**#	11.52±3.09^**###	1.27±0.49^**##	3.06±2.00^**
未感染组	64	2.39±0.82^**	8.77±2.74^**	1.03±0.43^**	3.94±3.61^**
正常对照组	98	0.88±0.23	8.01±1.35	0.76±0.12	1.27±0.64
统计值		8.341	5.007	1.767	67.574
P值		<0.001	<0.001	<0.001	<0.001
组别	PLR	MPR	累及器官
组别	PLR	MPR	关节/[例（%）]	胃肠道/[例（%）]	肾脏/[例（%）]
ASO组	128.34±46.44	0.032±0.010	28（60.87）	22（47.83）	28（60.87）
未感染组	168.75±89.26^**	0.029±0.008^*	32（50.00）	39（60.94）	37（57.81）
正常对照组	113.07±27.81	0.030±0.010
统计值	13.648	11.219	1.275	2.523	0.103
P值	0.001	0.004	0.259	0.112	0.748

组别	例数	IgA/（g/L）	IgG/（g/L）	IgM/（g/L）	NLR	PLR	MPR
ASO-HSPN组	29	2.75±0.75	10.95±2.75	1.21±0.53	2.85±2.15	121.57±41.56	0.040±0.010
ASO-HSP组	18	2.98±1.33	12.27±3.51	1.34±0.44	3.39±1.76	138.88±52.66	0.030±0.010
t值		0.683	1.330	-1.160	-1.463	1.241	-3.174
P值		0.501	0.190	0.246	0.143	0.221	0.002

组别	例数	IgA/（g/L）	IgG/（g/L）	IgM/（g/L）	NLR	PLR	MPR
ASO-HSPN组	29	2.75±0.75	10.95±2.75	1.21±0.53	2.85±2.15	121.57±41.56	0.040±0.010
ASO-HSP组	18	2.98±1.33	12.27±3.51	1.34±0.44	3.39±1.76	138.88±52.66	0.030±0.010
t值		0.683	1.330	-1.160	-1.463	1.241	-3.174
P值		0.501	0.190	0.246	0.143	0.221	0.002