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