半乳糖缺陷IgA1在儿童紫癜性肾炎早期诊断中的意义

康志娟; 刘波; 李志辉; 段翠蓉; 吴天慧; 寻劢; 张翼; 丁云峰; 傅汝倩

doi:10.7499/j.issn.1008-8830.2019.02.013

PDF(1275 KB)

HTML

中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (2) : 172-175. DOI: 10.7499/j.issn.1008-8830.2019.02.013

论著·临床研究

半乳糖缺陷IgA1在儿童紫癜性肾炎早期诊断中的意义

康志娟, 刘波, 李志辉, 段翠蓉, 吴天慧, 寻劢, 张翼, 丁云峰, 傅汝倩

作者信息 +

Value of galactose-deficient IgA1 in the early diagnosis of Henoch-Schönlein purpura nephritis in children

KANG Zhi-Juan, LIU Bo, LI Zhi-Hui, DUAN Cui-Rong, WU Tian-Hui, XUN Man, ZHANG Yi, DING Yun-Feng, FU RuQian

Author information +

文章历史 +

摘要

目的探讨半乳糖缺陷IgA1（Gd-IgA1）在儿童紫癜性肾炎（HSPN）早期诊断中的价值。方法以2018年1~4月确诊为HSPN的住院患儿67例、过敏性紫癜（HSP）住院患儿58例为研究对象，另选取20例行健康体检儿童作为健康对照组。采用ELISA法检测血清、尿液Gd-IgA1水平。以受试者工作特征曲线（ROC）分析血清Gd-IgA1及尿液Gd-IgA1/尿肌酐比值对HSPN的诊断价值。结果 HSP及HSPN患儿血清Gd-IgA1、尿液Gd-IgA1/尿肌酐比值均高于健康对照组（P < 0.01），且以HSPN患儿升高更明显（P < 0.01）。血清Gd-IgA1水平≥ 1 485.57 U/mL和/或尿液Gd-IgA1/尿肌酐比值≥ 105.74时，对诊断HSPN有较好的意义。49例HSP患儿随访6个月，随访中HSPN发病率为47%（23/49）；其中，血清Gd-IgA1 ≥ 1 485.57 U/mL患儿HSPN发病率为100%，尿液Gd-IgA1/尿肌酐比值≥ 105.74患儿HSPN发病率为73%。结论血清及尿液GdIgA1对HSPN的早期诊断有较好的临床价值。

Abstract

Objective To explore the value of galactose-deficient IgA1 (Gd-IgA1) in the early diagnosis of Henoch-Schönlein purpura nephritis (HSPN) in children. Methods A total of 67 hospitalized children who were definitely diagnosed with HSPN between January and April 2018 and 58 hospitalized children with Henoch-Schönlein purpura (HSP) were enrolled in the study. Twenty children undergoing routine physical examinations served as controls. The levels of serum and urine Gd-IgA1 were determined using ELISA. The receiver operating characteristic curve was used to analyze the value of serum Gd-IgA1 and urine Gd-IgA1/urine creatinine ratio in the diagnosis of HSPN. Results The level of serum Gd-IgA1 and urine Gd-IgA1/urine creatinine ratio in children with HSP or HSPN were significantly higher than those in healthy control group (P < 0.01), with a significantly greater increase observed in children with HSPN (P < 0.01). Serum Gd-IgA1 ≥ 1485.57 U/mL and/or urine Gd-IgA1/urine creatinine ratio ≥ 105.74 were of favorable value in the diagnosis of HSPN. During the six-month follow-up of the 49 children with HSP, the incidence of HSPN was 47% (23/49), which included a 100% incidence in children with serum Gd-IgA1 ≥ 1485.57 U/mL and a 73% incidence in children with urine Gd-IgA1/urine creatinine ratio ≥ 105.74. Conclusions Serum and urine Gd-IgA1 is of favorable clinical value in the early diagnosis of HSPN.

导出引用

康志娟, 刘波, 李志辉, 段翠蓉, 吴天慧, 寻劢, 张翼, 丁云峰, 傅汝倩. 半乳糖缺陷IgA1在儿童紫癜性肾炎早期诊断中的意义[J]. 中国当代儿科杂志. 2019, 21(2): 172-175 https://doi.org/10.7499/j.issn.1008-8830.2019.02.013

KANG Zhi-Juan, LIU Bo, LI Zhi-Hui, DUAN Cui-Rong, WU Tian-Hui, XUN Man, ZHANG Yi, DING Yun-Feng, FU RuQian. Value of galactose-deficient IgA1 in the early diagnosis of Henoch-Schönlein purpura nephritis in children[J]. Chinese Journal of Contemporary Pediatrics. 2019, 21(2): 172-175 https://doi.org/10.7499/j.issn.1008-8830.2019.02.013

参考文献

[1] Chen JY, Mao JH. Henoch-Schönlein purpura nephritis in children:incidence, pathogenesis and management[J]. World J Pediatr, 2015, 11(1):29-34.
[2] Kawasaki Y, Ono A, Ohara S, et al. Henoch-Schönlein purpura nephritis in childhood:pathogenesis, prognostic factors and treatment[J]. Fukushima J Med Sci, 2013, 59(1):15-26.
[3] Kang Y, Park JS, Ha YJ, et al. Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura[J]. J Korean Med Sci, 2014, 29(2):198-203.
[4] Hastings MC, Moldoveanu Z, Suzuki H, et al. Biomarkers in IgA nephropathy:relationship to pathogenetic hits[J]. Expert Opin Med Diagn, 2013, 7(6):615-627.
[5] Renfrow MB, Mackay CL, Chamlmers MJ, et al. Analysis of O-glycan heterogeneity in IgA1 myeloma proteins by Fourier transform ion cyclotron resonance mass spectrometry:implications for IgA nephropathy[J]. Anal Bioanal Chem, 2007, 389(5):1397-1407.
[6] Sanders JT, Hastings MC, Moldoveanu Z, et al. Serial galactosedeficient IgA1 levels in children with IgA nephropathy and healthy controls[J]. Int J Nephrol, 2017, 2017:8210641.
[7] Placzek WJ, Yanagawa H, Makita Y, et al. Serum galactosedeficient-IgA1 and IgG autoantibodies correlate in patients with IgA nephropathy[J]. PLoS One, 2018, 13(1):e0190967.
[8] Yanagawa H, Suzuki H, Suzuki Y, et al. A panel of serum biomarkers differentiates IgA nephropathy from other renal diseases[J]. PLoS One, 2014, 9(5):e98081.
[9] Suzuki H, Allegri L, Suzuki Y, et al. Galact-deficient IgA1 as a candidate urinary polypeptide marker of IgA nephropathy[J]. Dis Markers, 2016, 2016:7806438.
[10] 中华医学会儿科学分会免疫学组, 《中华儿科杂志》编辑委员会. 儿童过敏性紫癜循证诊治建议[J]. 中华儿科杂志, 2013, 51(7):502-507.
[11] 中华医学会儿科学分会肾病学组. 儿童常见肾脏疾病诊治循证指南(二):紫癜性肾炎的诊治循证指南(试行)[J]. 中华儿科杂志, 2009, 47(12):911-913.
[12] Suzuki Y, Matsuzaki K, Suzuki H, et al. Serum levels of galactose-deficient immunoglobulin (Ig)A1 and related immune complex are associated with disease activity of IgA nephropathy[J]. Clin Exp Nephrol, 2014, 18(5):770-777.
[13] Heineke MH, Ballering AV, Jamin A, et al. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schönlein purpura)[J]. Autoimmun Rev, 2017, 16(12):1246-1253.
[14] de Almeida JL, Campos LM, Paim LB, et al. Renal involvement in Henoch-Schönlein purpura:a multivariate analysis of initial prognostic factors[J]. J Pediatr (Rio J), 2007, 83(3):259-266.
[15] Zickerman AM, Allen AC, Talwar V, et al. IgA myeloma presenting as Henoch-Schönlein purpura with nephritis[J]. Am J Kidney Dis, 2000, 36(3):E19.
[16] Allen AC, Willis FR, Beattie TJ, et al. Abnormal IgA glycosylation in Henoch-Schönlein purpura restricted to patients with clinical nephritis[J]. Nephrol Dial Transplant, 1998, 13(4):930-934.