【摘要】 目的:探讨过敏性紫癜患儿血清中期因子(midkine,MK)变化的临床意义。方法:以本院2013年3月至2016年3月收治的106例过敏性紫癜患儿(henoch-sch(o|¨)nlein purpura,HSP)为研究对象,同期行健康体检的80例志愿者为对照组。酶联免疫吸附试验(ELISA)法测定外周血MK、白介素2(IL-2)、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF)、γ干扰素(IFN-γ)和IL-17。分析患儿生化指标包括白细胞计数(WBC)、血小板(Plt)、C反应蛋白(CRP)、血沉(ESR)、D-二聚体(D-Dimer)、免疫球蛋白A(IgA)、IgE、IgG、IgM等临床资料。结果:106例患儿中42例患者合并肾损害(孤立性血尿4例、孤立性蛋白尿17例、血尿合并蛋白尿21例)。过敏性紫癜患儿和对照者MK水平分别为291.70(248.50-396.41)pg/ml和217.30(198.98-243.65)Pg/ml(P<0.05)。HSP合并肾炎组MK水平326.58(266.58-459.25)pg/ml,高于HSP不合并肾炎组的MK水平280.72(233.67-384.36)pg/ml(P<0.05)。过敏性紫癜患儿IL-4、IL-6、IL-17、TNF和IFN-γ均高于对照组(P<0.05),而IL-10低于对照组。IL-2水平差异无统计学意义。HSP伴肾炎组和HSP不伴肾炎组之间细胞因子差异均无统计学意义。Pearson相关分析结果显示,MK与IL4、IL-6、IL-17、IgA和IgE均呈正相关(P<0.05)。ROC曲线分析显示,MK的AUC为0.902,95%,CI为0.841-0.963(P<0.001),阈值为295.50 pg/ml。MK预测过敏性紫癜肾炎的敏感性和特异性分别为80.60%和88.30%。结论:血浆MK在过敏性紫癜和过敏性紫癜伴肾炎的发生发展中起着重要作用。血浆MK可作为旱期诊断HSP和预测肾损害的有效指标。更多还原

【Abstract】 Objective:To investigate the clinical significance of serum midkine(MK) in children with henochschonlein purpura(HSP).Methods:One hundred and six children with HSP admitted in our hospital from March 2013 to March 2016 were enrolled in HSP group,but then 80 healthy volunteers were used as control.MK,interleukin-2(IL-2),IL-4,IL-6,IL-10,tumor necrosis factor(TNF),interferon-y(IFN-7) and IL-17 in peripheral blood were measured by ELISA,biochemical indicators including white blood cell count(WBC),platelet(Pit),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),D-dimer,immunoglobulin A(IgA),IgE,IgG,IgM and other clinical data were recorded and analyzed.Results:Among 106 cases of henoch-schonlein purpura,42 patients combined with renal failure(isolated hematuria in 4 cases,17 cases of isolated proteinuria,hematuria and proteinuria in 21 cases).Midkine level in children with HSP was significantly higher than that in the control group[291.70(248.50- 396.41)pg/ml vs 217.30(198.98-243.65) pg/ml)](P <0.05);the MK level in group of HSP with nephritis was higher than that in group of HSP without nephritis[326.58(266.58- 459.25) pg/ml vs 280.72(233.67- 384.36) pg/ml](P <0.05).IL-4,IL-6,IL-17,TNF and IFN-7 levels in children with HSP were higher than those in the control group(P <0.05),but IL-10 level was lower than that in control group.DL-2 level was not significantly different between 2 groups.Cytokines levels in HSP nephritis group and HSP without renal involvement were not significantly different.Pearson correlation analysis showed that midkine level positively correlated with IL-4,IL-6,IL-17,IgA and IgE(P <0.05).By ROC curve analysis,the AUC of midkine was 0.902,95%CI 0.841- 0.963(P < 0.001),threshold 295.50 pg/ml.The sensitivity and specificity of midkine for predicting Henoch-Schonlein purpura nephritis were 80.60%and88.30%respecitvely.Conclusion:Plasma MK plays an important role in the development of Henoch-Schonlein purpura and Henoch-Schonlein purpura nephritis.Plasma MK can be used as an effective indicator for early diagnosis and prediction of HSP and renal damage.更多还原