血管细胞黏附分子-1水平对儿童过敏性紫癜预后诊断的临床价值

摘要

Objective To explore the prognostic value of APN using measurements of plasm level of VCAM-1 in children with non-renal involvement allergic purpura(AP). Methods A diagnostic test was employed in the study. The children with non-renal involvement AP were enrolled in the study. The patients were divided into two groups , APN group and non-APN group(the negative control group), based on the results of follow up in the 24 months. The plasm level of VCAM-1 was detected to analyse the prognostic value of APN in children with non-renal involvement AP. Results 85 cases were available in the study and 16 patients were in APN group, 69 patients were in the negative control group. The serum level of VCAM-1 in APN group was significantly higher than the negative control group (Z=2.716, P=0.0066<0.01); The area below ROS curve was 71.2%(95% CI 0.603-0.805). It indicates that VCAM-1 was important in prognostic value of APN in children with non-renal involvement AP. Four cut-off points of VCAM-1 in plasm, 1670μg/L, 1870μg/L, 1980μg/L and 2110μg/L were selected based on the clinical practice and ROS curve. When the cut-off points of VCAM-1 in plasm were 1670μg/L, 1870μg/L, 1980μg/L and 2110μg/L, the sensitivity was 62.50%, 56.25%, 56.25%and 43.75%;the specificity was 59.42%, 89.86%, 94.20% and 95.65%; VCAM-1 1980μg/L can cover the sensitivity and specificity at greatest degree, it was the ideal cut-off point. Conclusion Plasm level of VCAM-1 in children with non-renal involvement AP is important to judge prognostic value of APN, The ideal cut-off point is 1980μg/L.%目的：探讨血管细胞黏附分子-1（VCAM-1）对无肾损害的过敏性紫癜（AP）日后发生紫癜性肾炎（APN）的预后诊断中的临床价值。方法采用诊断试验的研究方法，研究样本为早期无肾损害的AP患儿85例，跟踪随访2年，根据随访结果，将研究对象分为APN组（病例组）和非APN组（对照组），分析血浆VCAM-1水平对早期无肾损害的AP日后发生APN的预后诊断的临床价值。结果横断面研究资料85例中，病例组16例，对照组69例，其血浆VCAM-1水平病例组显著高于对照组（Z＝2.716，P＝0.0066＜0.01）；受试者运算特征（ROC）曲线下的面积为71.2%（95%可信区间为0.603～0.805），提示血浆VCAM-1对无肾损害AP发生APN的预后诊断具有重要意义。根据临床实用意义和ROC曲线，选取血浆VCAM-1的4个截断点：1670µg/L、1870µg/L、1980µg/L和2110µg/L，它们的敏感性分别是62.50%、56.25%、56.25%和43.75%；特异性分别是59.42%、89.86%、94.20%和95.65%。血浆VCAM-1含量1980µg/L能最大程度兼顾敏感性和特异性，为理想的截断点。结论对早期无肾损害的AP病儿，检测血浆VCAM-1对日后发生APN的预后诊断有重要的临床意义，其最佳诊断截断点为1980µg/L。