Application of neutrophil to lymphocyte ratio in clinical and pathological studies of children with Henoch-Schonlein purpura nephritis
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目的 分析不同中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratios,NLR)的过敏性紫癜性肾炎(Henoch-Schonlein purpura nephritis,HSPN)患儿的临床和病理表现,探索NLR在HSPN进展中的应用价值.方法 选取2018年3月至2023年10月在河南中医药大学第一附属医院肾脏病中心住院的患儿,共计292例,根据NLR的检测水平按照三分位数分组,其中低分位组(<1.483)96例、中分位组(1.483～2.902)99例、高分位组(>2.902)97例.比较3组间的临床资料和病理学特征.结果 NLR高分位组、中分位组的24 h尿蛋白(24-hour urinary protein,24 h UP)定量、尿蛋白/尿肌酐(urinary protein/creatinine,UPCR)、尿红细胞(urinary red blood cell,URBC)计数高于低分位组(P<0.05),且高分位组的24 h UP高于中分位组(P<0.05);血清IgA、IgG,补体C3、C4在3组间差异无统计学意义(P>0.05);HSPN患儿病理学分级主要以Ⅱ级、Ⅲ级为主,其中高分位组的Ⅲ级、Ⅳ级患儿占比高于中分位、低分位组(x2=36.377,P<0.01);高分位组有新月体形成的患儿占比高于中、低分位组(x2=39.683,P<0.01);接受者操作特征曲线(receiver operating characteristic curve,ROC)分析结果显示,NLR具有预测新月体形成的价值,AUC>0.7(P<0.01),敏感度为58.57％,特异性为79.27％.结论 伴高NLR水平的HSPN患儿蛋白尿、血尿水平升高,病理学分级较高,肾小球易形成新月体病变,且NLR有预测新月体形成的价值.
Objective Analyze the clinical and pathological manifestations of children with Henoch-Schonlein purpura nephritis (HSPN) with different neutrophil-to-lymphocyte ratios (NLR),and explore the significance of NLR in the progression of HSPN. Methods 292 children admitted to the Kidney Disease Center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from March 2018 to October 2023 were selected. According to the level of NLR detection,they were divided into three quartiles:96 in the low quartile group (<1.483),99 in the middle quartile group (1.483～2.902),and 97 in the high quartile group (>2.902). The clinical data and pathological features among the three groups were compared. Results The 24-hour urinary protein (24-hour UP) quantification,urinary protein/creatinine (UPCR),and urinary red blood cell (URBC) count in the high and middle percentile groups of NLR were higher than those in the low percentile group (P<0.05),and the 24-hour UP in the high percentile group was higher than that in the middle percentile group (P<0.05);There was no statistically significant difference in serum IgA,IgG,and complement C3,C4 among the three groups(P>0.05);The pathological grading of HSPN patients is mainly grade Ⅱ and Ⅲ,with a higher proportion of grade Ⅲ and Ⅳ patients in the high quartile group compared to the middle and low quartile groups (x2=36.377,P<0.01);The proportion of children with crescent formation in the high percentile group was higher than that in the middle and low percentile groups (x2=39.683,P<0.01);The receiver operating characteristic (ROC) curve analysis results showed that NLR has the value of predicting crescent formation,with AUC>0.7 (P<0.01),sensitivity of 58.57％,and specificity of 79.27％.Conclusion Children with HSPN with high NLR levels have elevated levels of proteinuria and hematuria,severe pathological grading,and are prone to crescent formation in the glomeruli. NLR has predictive value for crescent formation.
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