血清Lp-PLA2在儿童早期慢性肾脏病病情评估中的价值

doi:10.3969/j.issn.1673-8640.2026.03.009

摘要/Abstract

摘要：

目的探讨血清脂蛋白相关磷脂酶A2（Lp-PLA2）在儿童早期慢性肾脏病（CKD）病情评估中的临床价值。方法选取2024年1—6月复旦大学附属儿科医院G1期~G3b期CKD患儿192例（CKD组）、急性肾损伤（AKI）患儿30例（AKI组）和健康体检者50名（正常对照组）。收集所有研究对象的临床资料，并检测血清Lp-PLA2水平和肾功能指标。根据估算肾小球滤过率（eGFR）将CKD患儿分为G1期组（37例）、G2期组（48例）、G3a期组（54例）、G3b期组（53例），根据年龄分为<6岁组（42例）、7~12岁组（93例）、13~18岁组（57例），根据是否行肾移植分为肾移植组（106例）和未肾移植组（86例）。采用Spearman相关分析评估Lp-PLA2与肾功能指标的相关性。采用受试者工作特征（ROC）曲线评价Lp-PLA2判断儿童CKD严重程度的效能。结果 CKD组血清Lp-PLA2水平显著高于AKI组和正常对照组（P<0.000 1），且随CKD分期的升高而升高（P<0.001）。<6岁组、7~12岁组、13~18岁组和肾移植组、未肾移植组Lp-PLA2水平均随CKD分期的升高而升高（P<0.05），各分期患儿之间差异均有统计学意义（P<0.05）。CKD患儿Lp-PLA2与SCr、BUN和Cys C均正相关（r值分别为0.574 8、0.470 3、0.514 5，P<0.05），与eGFR呈负相关（r=-0.831 4，P<0.05）。SCr、BUN、Cys C、Lp-PLA2判断CKD患儿G3a期的曲线下面积（AUC）分别为0.796、0.732、0.790、0.982，判断CKD患儿G3b期的AUC分别为0.671、0.851、0.817、0.903。结论 Lp-PLA2在儿童早期CKD病情评估中具有潜在的临床应用价值，可作为病情评估的指标之一。

关键词: 脂蛋白相关磷脂酶A2, 儿童, 慢性肾脏病, 病情评估

Abstract:

Objective To investigate the clinical role of serum lipoprotein-associated phospholipase A2（Lp-PLA2）in the disease assessment of chronic kidney disease（CKD）in children. Methods A total of 192 children with stage G1 to G3b CKD at the Children's Hospital of Fudan University，30 children with acute kidney injury（AKI）and 50 healthy subjects were enrolled. The clinical data were collected，and serum Lp-PLA2 levels and renal function indicators were determined. CKD children were classified into stage G1 group（37 cases），stage G2 group（48 cases），stage G3a group（54 cases）and stage G3b group（53 cases）based on estimated glomerular filtration rate（eGFR）. They were also classified into <6-year-old group（42 cases），7-12-year-old group（93 cases），13-18-year-old group（57 cases）and renal transplantation group（106 cases），non-renal transplantation group（86 cases）. Spearman correlation analysis was used to evaluate the correlation between Lp-PLA2 and renal function indicators. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of Lp-PLA2 in assessing the severity of childhood CKD. Results The serum Lp-PLA2 level in CKD group was higher than those in AKI group and healthy control group（P<0.000 1），and it was increased with the progression of CKD stages（P<0.001）. The Lp-PLA2 levels in <6-year-old group，7-12-year-old group，13-18-year-old group and renal transplantation group，non-renal transplantation group were all increased with the progression of CKD stages（p<0.05），and the differences among the stages were statistically significant（P<0.05）. Lp-PLA2 was positively correlated with serum creatinine（SCr），blood urea nitrogen（BUN）and cystatin C（Cys C）in CKD children（r values were 0.574 8，0.470 3 and 0.514 5，respectively，p<0.05），and it was negatively correlated with eGFR（r=-0.831 4，P<0.05）. The areas under curves（AUC）for SCr，BUN，Cys C and Lp-PLA2 in diagnosing CKD in stage G3a were 0.796，0.732，0.790 and 0.982，respectively，and those for diagnosing CKD in stage G3b were 0.671，0.851，0.817 and 0.903，respectively. Conclusions Lp-PLA2 has potential clinical application value in the assessment of early-stage childhood CKD and can be used as one of the indicators for disease assessment.

Key words: Lipoprotein-associated phospholipase A2, Children, Chronic kidney disease, Disease assessment

中图分类号:

Q556

沈徐婷, 叶志成, 张磊, 赵若楠. 血清Lp-PLA2在儿童早期慢性肾脏病病情评估中的价值[J]. 检验医学, 2026, 41(3): 265-271.

SHEN Xuting, YE Zhicheng, ZHANG Lei, ZHAO Ruonan. Role of serum Lp-PLA2 in disease assessment of children with early-stage chronic kidney disease[J]. Laboratory Medicine, 2026, 41(3): 265-271.

图/表 10

参考文献 34

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项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	Youden指数
G3a期
SCr	0.796（0.728~0.854）	136.7 μmol·L^-1	85.88	57.01	0.43
BUN	0.732（0.659~0.797）	8.98 mmol·L^-1	83.33	62.62	0.46
Cys C	0.790（0.722~0.849）	1.64 mg·L^-1	75.32	74.74	0.50
Lp-PLA2	0.982（0.949~0.996）	178.1mg·L^-1	97.65	88.79	0.86
G3b期
SCr	0.671（0.619~0.754）	99.4 μmol·L^-1	75.47	48.20	0.24
BUN	0.851（0.792~0.898）	10.17 mmol·L^-1	75.38	86.23	0.62
Cys C	0.817（0.748~0.870）	1.69 mg·L^-1	86.67	65.35	0.52
Lp-PLA2	0.903（0.851~0.941）	189.9 mg·L^-1	92.45	82.01	0.74

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	Youden指数
G3a期
SCr	0.796（0.728~0.854）	136.7 μmol·L^-1	85.88	57.01	0.43
BUN	0.732（0.659~0.797）	8.98 mmol·L^-1	83.33	62.62	0.46
Cys C	0.790（0.722~0.849）	1.64 mg·L^-1	75.32	74.74	0.50
Lp-PLA2	0.982（0.949~0.996）	178.1mg·L^-1	97.65	88.79	0.86
G3b期
SCr	0.671（0.619~0.754）	99.4 μmol·L^-1	75.47	48.20	0.24
BUN	0.851（0.792~0.898）	10.17 mmol·L^-1	75.38	86.23	0.62
Cys C	0.817（0.748~0.870）	1.69 mg·L^-1	86.67	65.35	0.52
Lp-PLA2	0.903（0.851~0.941）	189.9 mg·L^-1	92.45	82.01	0.74