The Predictive Value of sFlt-1,SDC4,and sST2 on the Therapeutic Effect of Children with Purpuric Nephritis
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摘要:
目的 探讨紫癜性肾炎(henoch-schnlein purpura nephritis,HSPN)患儿血清可溶性血管内皮生长因子受体-1(soluble vascular endothelial growth factor receptor-1,sFlt-1)、多配体蛋白聚糖-4(polyligand proteoglycan-4,SDC4)、可溶性人基质裂解素2(soluble human stromal lysin 2,sST2)水平与肾组织病理分级相关性,并分析其对治疗效果的预测价值。 方法 回顾性选取2021年4月至2023年4月信阳一五四医院收治的98例HSPN患儿作为研究对象,依据治疗2个月后临床疗效分为有效组(n=78)和无效组(n=20),比较其临床资料及治疗前、治疗1个月后血清sFlt-1、SDC4、sST2水平。多因素Logistic回归分析疗效影响因素。分析治疗1个月后血清sFlt-1、SDC4、sST2水平对治疗2个月后疗效的预测价值。 结果 随着病理分级增加,血清sFlt-1、SDC4、sST2水平呈上升趋势(P < 0.05);无效组治疗1个月后血清sFlt-1、SDC4、sST2水平高于有效组(P < 0.05);紫癜症状评分、免疫球蛋白A(immunoglobulin A,IgA)水平及治疗1个月后血清sFlt-1、SDC4、sST2水平为疗效的独立危险因素(P < 0.05);治疗1个月后血清sFlt-1、SDC4、sST2水平联合预测疗效的AUC大于任意2项联合预测、单项指标预测(P < 0.05)。 结论 HSPN患儿血清sFlt-1、SDC4、sST2水平与肾脏组织病理分级密切相关,联合检测其水平对治疗效果具有一定预测价值。 -
关键词:
- 紫癜性肾炎 /
- 可溶性血管内皮生长因子受体-1 /
- 多配体蛋白聚糖-4 /
- 可溶性人基质裂解素2 /
- 预测
Abstract:Objective To investigate the correlation between the levels of soluble vascular endothelial growth factor receptor-1 (sFlt-1), polyligand proteoglycan-4 (SDC4), soluble human stromal lysin 2 (sST2) in serum and renal histopathological grading in children with Henoch-Schnlein purpura nephritis (HSPN), and analyze their predictive value for therapeutic efficacy. Methods A retrospective study was conducted, in which 98 children with HSPN admitted to Xinyang 154th Hospital from April 2021 to April 2023 were selected as the research subjects. According to the clinical efficacy after 2 months of treatment, they were divided into an effective group of 78 cases and an ineffective group of 20 cases. Their clinical data and the levels of serum sFlt-1, SDC4, and sST2 before and after treatment were compared. Multivariate logistic regression analysis was used to analyze the factors affecting the efficacy. The predictive value of serum sFlt-1, SDC4, and sST2 levels after 1 month of treatment on the efficacy after 2 months of treatment was analyzed. Results As the pathological grade increased, the levels of serum sFlt-1, SDC4, and sST2 showed an upward trend (P < 0.05); the levels of serum sFlt-1, SDC4, and sST2 in the ineffective group after 1 month of treatment were higher than those in the effective group (P < 0.05); the symptom score of purpura, immunoglobulin A (IgA) level, and the levels of serum sFlt-1, SDC4, and sST2 after 1 month of treatment were independent risk factors for efficacy (P < 0.05); the AUC of serum sFlt-1, SDC4, and sST2 levels combined to predict efficacy after 1 month of treatment was greater than that of any two combined predictions or single indicator predictions (P < 0.05). Conclusion The levels of serum sFlt-1, SDC4, and sST2 in children with HSPN are closely related to the pathological grading of the kidney tissue. The combined detection of their levels has certain predictive value for the therapeutic effect. -
表 1 不同病理分级患儿血清sFlt-1、SDC4、sST2水平比较($\bar x \pm s $)
Table 1. Comparison of serum sFlt-1,SDC4,and sST2 levels in children with different pathologic grades ($\bar x \pm s $)
组别 n sFlt-1(pg/mL) SDC4(ng/mL) sST2(pg/mL) Ⅰ级 15 411.63±107.21 11.30±3.02 1085.36±221.78 Ⅱ级 38 786.34±162.15* 17.52±2.16* 1574.29±224.76* Ⅲ级 31 1263.35±250.87*# 25.63±3.57*# 2065.34±262.67*# Ⅳ级 14 2069.95±319.98*#& 42.42±3.14*#& 3692.73±330.91*#& F 177.889 335.403 308.121 P <0.001 <0.001 <0.001 与Ⅰ级比较,*P < 0.05;与Ⅱ级比较,#P < 0.05;与Ⅲ级比较,&P < 0.05。 表 2 有效与无效患儿临床资料比较[($\bar x \pm s $)/n(%)]
Table 2. Comparison of clinical data of effective and ineffective children [($\bar x \pm s $)/n(%)]
临床资料 无效(n=20) 有效(n=78) t/χ2 P 性别 0.013 0.910 男 11(55.00) 44(56.41) 女 9(45.00) 34(43.59) 年龄(岁) 8.63±1.17 9.02±1.06 1.437 0.154 体质量指数(kg/m2) 17.55±2.03 18.28±1.75 1.610 0.111 病理分级 0.730 0.866 Ⅰ级 4(20.00) 11(14.10) Ⅱ级 8(40.00) 30(38.46) Ⅲ级 5(25.00) 26(33.33) Ⅳ级 3(15.00) 11(14.10) D-二聚体(μg/L) 60.33±5.24 61.02±5.74 0.488 0.627 凝血酶原时间(s) 8.62±1.63 8.71±1.77 0.206 0.837 纤维蛋白原(g/L) 12.82±1.27 12.71±1.33 0.333 0.740 活化部分凝血时间(s) 15.06±2.11 14.92±2.17 0.259 0.796 CD3+(%) 52.16±5.24 53.11±4.19 0.858 0.393 CD4+(%) 25.99±3.21 25.94±3.14 0.063 0.950 CD8+(%) 27.45±3.16 27.61±3.02 0.209 0.835 24 h尿蛋白含量(mg) 942.61±114.20 878.52±122.84 2.110 0.037 尿红细胞计数(个/μL) 226.31±30.21 201.74±27.24 3.520 0.001* 呼吸道病原体感染 0.699 0.403 有 13(65.00) 58(74.36) 无 7(35.00) 20(25.64) EB病毒感染 0.009 0.926 有 9(45.00) 36(46.15) 无 11(55.00) 42(53.85) IgA(g/L) 2.55±0.52 1.68±0.36 8.747 <0.001* IgG(g/L) 9.06±2.02 8.87±2.15 0.357 0.722 紫癜症状评分(分) 7.58±1.52 5.61±1.17 6.303 <0.001* *P < 0.05。 表 3 有效与无效患儿血清sFlt-1、SDC4、sST2水平比较($\bar x \pm s $)
Table 3. Comparison of serum sFlt-1,SDC4 and sST2 levels between effective and ineffective children($\bar x \pm s $)
组别 n sFlt-1(pg/mL) SDC4(ng/mL) sST2(pg/mL) 治疗前 治疗1个月后 治疗前 治疗1个月后 治疗前 治疗1个月后 无效 20 1055.96±251.98 635.25±111.75* 23.01±4.67 16.03±3.34* 1988.54±362.87 1563.29±321.11* 有效 78 1065.12±255.04 502.31±127.43* 22.61±6.53 11.08±3.29* 1949.44±349.81 1165.49±368.46* t 0.144 4.261 0.257 5.985 0.443 4.414 P 0.886 <0.001 0.798 <0.001 0.659 <0.001 与同组治疗前比较,*P < 0.05。 表 4 多因素分析
Table 4. Multi-factor analysis
影响因素 β S.E. Waldχ2 P OR 95%CI sFlt-1 1.404 0.626 5.027 <0.001* 4.070 2.014~8.224 SDC4 1.694 0.574 8.714 <0.001* 5.443 3.215~9.216 sST2 2.097 0.613 11.707 <0.001* 8.145 2.574~10.013 24 h尿蛋白含量、尿红细胞计数、紫癜症状评分、IgA及治疗1个月后血清sFlt-1、SDC4、sST2水平均设为实测值。*P < 0.05。 表 5 ROC分析血清sFlt-1、SDC4、sST2水平对疗效的预测价值
Table 5. Predictive value of serum sFlt-1,SDC4,and sST2 levels for efficacy by ROC analysis
指标 AUC 95%CI cut-off 敏感度(%) 特异度(%) P sFlt-1(pg/mL) 0.776 0.681~0.854 >588.9 70.00 76.92 <0.001* SDC4(ng/mL) 0.769 0.673~0.848 >21.2 75.00 74.36 <0.001* sST2(pg/mL) 0.774 0.679~0.853 >1366.84 90.00 69.23 <0.001* sFlt-1+SDC4 0.867 0.783~0.927 − 85.00 88.46 <0.001* sFlt-1+sST2 0.852 0.766~0.916 − 85.00 75.64 <0.001* SDC4+sST2 0.858 0.773~0.921 − 75.00 87.18 <0.001* sFlt-1+SDC4+sST2 0.923 0.851~0.967 − 85.00 91.03 <0.001* *P < 0.05。 -
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