Clinical roles of NLR，PLR，MPR and immunoglobulin determination in ASO-positive HSPN children

doi:10.3969/j.issn.1673-8640.2023.06.016

Abstract

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

CLC Number:

R446.1

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.

Figures/Tables 3

References 16

[1]	ONI L, SAMPATH S. Childhood IgA vasculitis(Henoch Schonlein purpura)-advances and knowledge gaps[J]. Front Pediatr, 2019, 7:257. DOI URL
[2]	WANG J J, XU Y, LIU F F, et al. Association of the infectious triggers with childhood Henoch-Schonlein purpura in Anhui province,China[J]. J Infect Public Health, 2020, 13(1):110-117. DOI URL
[3]	OZEN S, RUPERTO N, DILLON M J, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides[J]. Ann Rheum Dis, 2006, 65(7):936-941. DOI PMID
[4]	HEINEKE M H, BALLERING A V, JAMIN A, et al. New insights in the pathogenesis of immunoglobulin A vasculitis(Henoch-Schönlein purpura)[J]. Autoimmun Rev, 2017, 16(12):1246-1253. DOI URL
[5]	ARSLANSOYU ÇAMLAR S, SOYLU A,AKIL, et al. Henoch-Schonlein purpura,post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection[J]. Paediatr Int Child Health, 2018, 38(1):73-75. DOI URL
[6]	闫京京, 张京荣. 链球菌感染致过敏性紫癜患者血清免疫学及炎症指标分析[J]. 白求恩医学杂志, 2020, 18(4):346-348.
[7]	陈希, 陈一伟, 高春强. 尿β2-m、IgG、Alb RIA联检观察肾功能受损的临床价值[J]. 放射免疫学杂志, 2008, 21(6):569-570.
[8]	姚翠婵, 曾华松, 王蓓, 等. 链球菌感染与儿童过敏性紫癜肾损害的关系[J]. 广东医学, 2008, 29(11):1831-1833.
[9]	THOMPSON C B, JAKUBOWSKI J A. The pathophysiology and clinical relevance of platelet heterogeneity[J]. Blood, 1988, 72(1):1-8. PMID
[10]	CHO J, LEE S, UH Y, et al. Usefulness of mean platelet volume to platelet count ratio for predicting the risk of mortality in community-acquired pneumonia[J]. Arch Med Sci, 2020, 16(6):1327-1335. DOI PMID
[11]	HAN X, XU P, DUAN X, et al. High mean platelet volume-to-platelet count ratio as a diagnostic maker for increased risk of liver function damage in pediatric patients with infectious mononucleosis in China[J]. Exp Ther Med, 2019, 18(6):4523-4527. DOI PMID
[12]	OH G H, CHUNG S P, PARK Y S, et al. Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis[J]. Shock, 2017, 47(3):323-330. DOI PMID
[13]	JASZCZURA M, GÓRA A, GRZYWNA-ROZENEK E, et al. Analysis of neutrophil to lymphocyte ratio,platelet to lymphocyte ratio and mean platelet volume to platelet count ratio in children with acute stage of immunoglobulin A vasculitis and assessment of their suitability for predicting the course of the disease[J]. Rheumatol Int, 2019, 39(5):869-878. DOI
[14]	KARADAĞŞG, ÇAKMAK F, ÇIL B, et al. The relevance of practical laboratory markers in predicting gastrointestinal and renal involvement in children with Henoch-Schönlein purpura[J]. Postgrad Med, 2021, 133(3):272-277. DOI URL
[15]	MAKAY B, TÜRKYILMAZ Z, DUMAN M, et al. Mean platelet volume in Henoch-Schönlein purpura:relationship to gastrointestinal bleeding[J]. Clin Rheumatol, 2009, 28(10):1225-1228. DOI URL
[16]	GASPARYAN AY, AYVAZYAN L, MIKHAILIDIS DP, et al. Mean platelet volume:a link between thrombosis and inflammation?[J]. Curr Pharm Des, 2011, 17(1):47-58. DOI URL

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