摘要
目的观察急性肾盂肾炎(APN)患儿血清硫氧还原蛋白(S-Trx)、尿Trx(U-Trx)水平以及血清和尿液Trx比值(S-Trx/U-Trx),探讨其在APN早期诊断和病情预测中的价值。方法选择120例尿路感染患儿,按照APN诊断标准分为APN组(67例)和非APN组(53例)。67例APN患儿按照病情程度分为重症组(23例)和非重症组(44例)。收集各组患儿血清C-反应蛋白(CRP)、降钙素原(PCT)、胱抑素C(CysC)、S-Trx水平和尿β2微球蛋白(β2-MG)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、U-Trx水平,并计算S-Trx/U-Trx比值。采用受试者工作特征(ROC)曲线评价各指标对APN诊断和病情预测的价值。结果APN组血清PCT、S-Trx和尿β2-MG、尿NGAL、U-Trx水平均明显高于非APN组,S-Trx/U-Trx明显低于非APN组[(1.17±0.69)μg/L比(0.67±0.18)μg/L、(31.84±7.08)ng/ml比(26.04±6.09)ng/ml、(0.68±0.33)mg/L比(0.43±0.12)mg/L、(224.05±76.75)μg/L比(136.07±45.42)μg/L、(26.52±8.29)μg/L比(12.18±3.32)μg/L、1.30±0.48比2.30±0.84],差异有统计学意义(P<0.05或<0.01)。APN患儿中,重症组S-Trx、尿NGAL、Trx水平均明显高于非重症组,S-Trx/U-Trx明显低于非重症组[(34.99±8.27)ng/ml比(30.19±5.81)ng/ml、(266.54±67.40)μg/L比(201.84±72.44)μg/L、1.12±0.30比1.12±0.30],差异有统计学意义(P<0.01或<0.05)。APN患儿S-Trx与U-Trx水平呈正相关(r=0.404,P<0.01);重症APN患儿S-Trx与U-Trx水平呈正相关(r=0.669,P<0.01)。ROC曲线分析显示,U-Trx最佳临界值为16.17μg/L时,诊断APN的曲线下面积(AUC)为0.960(95%CI 0.907~0.987),特异度为94.34%,灵敏度为92.54%。S-Trx/U-Trx最佳临界值为1.29时,预测重症APN的AUC为0.798(95%CI 0.683~0.887),特异度为81.82%,灵敏度为82.61%。结论U-Trx可以作为儿童APN的早期诊断标志物,S-Trx/U-Trx可以作为预测APN病情加重的指标。
Objective To investigate the diagnostic and predictable value of the levels of serum Trx(S-Trx),urinary Trx(U-Trx)and S-Trx/U-Trx ratio in acute pyelonephritis of children.Methods A total of 120 children with urinary tract infection were divided into APN group(67 cases)and non-APN group(53 cases).In addition,67 children with APN were assigned to severe group(23 cases)and non-severe group(44 cases).The leves of serum C-reactive protein(CRP),precalcitonin(PCT),cystatin C(CysC),Trx(S-Trx)and urinary β2-microglobulin(β2-MG),neutrophill gelatinase-related apolipoprotein(NGAL),Trx(U-Trx) were collected.Besides,the ratio of S-Trx/U-Trx was also counted.The diagnostic and predictable value of each index were determined by receiver operating characteristic(ROC).Results Serum PCT,S-Trx,urinaryβ2-MG,NGAL,U-Trx was markedly increased and S-Trx/U-Trx ratio was obviously decreased in the APN group compared to that of the non-APN group(P<0.05).Moreover,S-Trx,urinary NGAL,U-Trx was significantly increased and S-Trx/U-Trx ratio was significantly decreased in the severe group compared to that of the non-severe group(P<0.05).Both in APN group or severe APN group,S-Trx and U-Trx displayed significantly positive correlation(P<0.05).The results from ROC demonstrated that AUC were 0.960,and optimal cut-off value were 16.17μg/L of U-Trx diagnostic APN in children,with a specificity and sensitivity of 94.34%and 92.54%,respectively.The optimal cut-off value was 1.29.AUC of S-Trx/U-Trx 0.960 predicted the severe of APN in children,with a specificity and sensitivity of 81.82%and 82.61%,respectively.Conclusions U-Trx is useful for diagnostic APN in children,S-Trx/U-Trx is an independent predictor of the severe APN.
作者
吕明珠
陈全景
查志刚
梅娥
Lyu Mingzhu;Chen Quanjing;Zha Zhigang;Mei E(Children′s Medical Center,Dongfeng Hospital of Hubei University Medicine,Hubei Shiyan 442001,China)
出处
《中国医师进修杂志》
2019年第12期1076-1080,共5页
Chinese Journal of Postgraduates of Medicine
