全身免疫炎癥指數和紅細胞分布寬度在兒童過敏性紫癜合并腎損害中的變化及意義

［摘要］目的探討全身免疫炎癥指數（SII）和紅細胞分布寬度（RDW）在預測兒童過敏性紫癜（HSP）合并腎損害中的臨床價值。方法選取2018年6月至2022年12月在南京醫科大學附屬淮安第一醫院住院治療的191例HSP患兒為研究對象，其中77例為腎損害組，114例為無腎損害組。分析兩組患兒的一般資料和實驗室檢查結果，通過多因素Logistic回歸分析HSP合并腎損害的危險因素；以Spearman相關性分析SII和RDW與24小時尿蛋白定量（24h-UPRO）之間的相關性；利用受試者工作特征（ROC）曲線評估SII和RDW對HSP合并腎損害的預測價值。結果兩組患兒的年齡（t=-2.449）、白細胞計數（t=-3.057）、血紅蛋白（t=-2.304）、紅細胞壓積（t=-2.630）、RDW（t=-8.617）、中性粒細胞計數（t=-2.788）、中性粒細胞/淋巴細胞比值（Z=-2.887）、SII（Z=-3.325）比較差異均有統計學意義（P＜0.05）。多因素Logistic回歸分析顯示，RDW（OR=1.861，95%CI：1.526～2.270，P＜0.001）、SII（OR=1.003，95%CI：1.001～1.005，P=0.008）均是HSP患兒發生腎損害的獨立危險因素。RDW、SII水平與24h-UPRO水平均呈正相關（r值分別為0.256、0.429，P＜0.05）。ROC曲線評估顯示，RDW預測HSP患兒合并腎損害的曲線下面積（AUC）為0.817（95%CI：0.757～0.877，P＜0.001），最佳截斷值為38.85fL，靈敏度和特異度分別為80.52%和70.18%；SII預測HSP患兒合并腎損害的AUC為0.642（95%CI：0.562～0.721，P=0.001），最佳截斷值為401.67×109/L，靈敏度和特異度分別為81.82%和43.86%；二者聯合預測HSP患兒合并腎損害的AUC為0.845（95%CI：0.790～0.900，P＜0.001），靈敏度和特異度分別為87.01%和71.93%。結論SII和RDW對預測HSP患兒合并腎損害有一定的臨床應用價值。

［關鍵詞］全身免疫炎癥指數；紅細胞分布寬度；過敏性紫癜；腎損害；兒童

Doi：10.3969/j.issn.1673-5293.2024.11.003

［中圖分類號］R179［文獻標識碼］A

［文章編號］1673-5293（2024）11-0013-07

Changes and significance of systemic immune-inflammation index and red blood cell distribution width

in children with Henoch-Schonlein purpura complicated with renal damage

QIU Yisha，WU Kai，HU Jian，SUN Xingzhen

（Department of Pediatrics，Huai′an First Peoples Hospital Affiliated to

Nanjing Medical University，Jiangsu Huai′an 223300，China）

［Abstract］ Objective To explore the clinical value of the systemic immune-inflammation index （SII） and red blood cell distribution width （RDW） in predicting renal damage in children with Henoch-Schonlein purpura （HSP）. Methods A total of 191 children with HSP who were hospitalized at Huai′an First Peoples Hospital affiliated to Nanjing Medical University from June 2018 to December 2022 were selected as the study objects.Among them，77 cases were in the renal damage group，and 114 cases were in the non-renal damage group.The general data and laboratory results of the two groups were analyzed.Multivariate Logistic regression analysis was used to identify risk factors for HSP complicated by renal damage.The correlation between SII and RDW with 24-hour urine protein （24h-UPRO） was analyzed using Spearman correlation analysis.Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of SII and RDW for HSP complicated by renal damage. Results There were statistically significant differences between the two groups of children in terms of age （t=-2.449），white blood cell count （t=-3.057），hemoglobin （t=-2.304），hematocrit （t=-2.630），RDW （t=-8.617），neutrophil count （t=-2.788），neutrophil/lymphocyte ratio （Z=-2.887），and SII （Z=-3.325）（P＜0.05）.Multivariate Logistic regression analysis showed that RDW （OR=1.861，95%CI：1.526-2.270，P＜0.001） and SII （OR=1.003，95%CI：1.001-1.005，P=0.008） were independent risk factors for renal damage in children with HSP.RDW and SII levels were positively correlated with 24h-UPRO levels （r=0.256 and 0.429，respectively，P＜0.05）.ROC curve evaluation showed that the area under the curve （AUC） of RDW in predicting renal damage in children with HSP was 0.817 （95%CI：0.757-0.877，P＜0.001），with an optimal cutoff value of 38.85fL，and the sensitivity and specificity were 80.52% and 70.18% respectively.The AUC of SII in predicting renal damage in children with HSP was 0.642 （95%CI：0.562-0.721，P=0.001），with an optimal cutoff value of 401.67×109/L，and the sensitivity and specificity were 81.82% and 43.86% respectively.When combined，the AUC for predicting renal damage in children with HSP was 0.845 （95%CI：0.790-0.900，P＜0.001），and the sensitivity and specificity were 87.01% and 71.93% respectively. Conclusion SII and RDW have certain clinical application value in predicting renal damage in children with HSP.

［Key words］ systemic immune-inflammation index;red blood cell distribution width;Henoch-Schonlein purpura;renal damage;child

過敏性紫癜（Henoch-Schnlein purpura，HSP）是兒童時期最常見的以白細胞破碎性血管炎為病理特征的全身性疾病［1］，主要表現為皮膚紫癜，伴有關節疼痛、腹痛、血尿或蛋白尿等。多數患兒預后良好，但若不能及時診斷及治療，在累及腎臟時即診斷為紫癜性腎炎（Henoch-Schonlein purpura nephritis，HSPN）后，可能出現進行性腎損害而影響患兒長期預后。……