紫癜性肾炎患儿纤维蛋白原与国际小儿肾脏病研究组病理分级及肾单位微观病变的关系研究
he Relationship between Fibrinogen and International Pediatric Nephrology Study Group Pathologic Grading and Microscopic Lesions of Renal Units with Henoch Schonlein Purpura Nephritis in Children
背景 临床中紫癜性肾炎（HSPN）患儿多存在纤维蛋白原（FIB）升高现象，但 FIB 与肾脏病变相关性的研究较少。目的 探讨 HSPN 患儿 FIB 与国际小儿肾脏病研究组（ISKDC）病理分级及肾单位部分微观病理变化的相关性，明确 FIB 能否评估 HSPN 患儿肾损伤轻重。方法 收集 2017 年 12 月—2022 年 12 月在河南中医药大学第一附属医院儿科肾病病区住院同时行肾活检的紫癜性肾炎患儿 922 例，汇总其做肾活检期间的临床信息、FIB 及肾脏病理信息，并依据 FIB 水平将患儿分为 A 组（偏低）4.98 g/L。采用 Spearman 秩相关分析探究 FIB 与 ISKDC 病理分级、肾小球系膜增生比例、新月体比例的相关性；再通过受试者工作特征（ROC）曲线分析 FIB 对肾单位微观病理变化的预测情况。结果 922 例已做肾活检的 HSPN 患儿中，FIB 为（3.48±1.01）g/L。A 组 113 例，FIB 偏低率 12.26%；B 组 734 例，FIB 标准率占 79.61%；C 组 75 例，FIB 偏高率占 8.13%。ISKDC 病理分级中Ⅱ a 型 173 例（18.76%）、Ⅱ b 型 29 例（3.15%）、Ⅲ a 型 466 例（50.54%）、Ⅲ b 型 232 例（25.16%）、Ⅳ型及以上 22 例（2.39%）（其中Ⅳ a 型 2 例，Ⅳ b 型 18 例，V 型 2 例）。Spearman 秩相关分析结果显示，HSPN 患儿 FIB 及 FIB 分组与肾脏病理 ISKDC 分级（rs=0.146，P<0.001；rs=0.129，P<0.001）呈正相关性。922 例 HSPN 患儿中有 911 例（98.9%）存在系膜细胞增生，655 例（71.04%）存在新月体增生。Spearman 秩相关分析结果显示，FIB、FIB 分组均与系膜细胞增生率呈弱正相关性（rs=0.092，P=0.005；rs=0.096，P=0.003），与新月体增生率呈正相关性（rs=0.132，P<0.001；rs=0.83，P=0.012）。922 例 HSPN 患儿中肾小球急性病变 763 例（82.75%）、急慢性病变 97 例（10.52%）、慢性病变 62 例（6.73%）。HSPN 患儿 FIB 与肾小球病变的急慢性情况呈正相关（rs=0.145，P<0.001）。同时，HSPN患儿部分肾活检指标病变（新月体形成、系膜增生分叶、肾小球硬化、球囊粘连、小管炎或再生、小管细胞颗粒变性、小管间质水肿、小管炎性细胞浸润、小管萎缩、小管间质纤维化、小管腔红细胞管型、肾间质血管）与 FIB 比较，差异有统计学意义（P<0.05）。ROC 曲线显示，FIB 对肾小球硬化的灵敏度最高（灵敏度 =0.900，特异度 =0.303），FIB最佳截断值为 2.835 mg/L；FIB 对小管间质纤维化正向预测的 ROC 曲线下面积（AUC）=0.623，对小管细胞颗粒变性反向预测的 AUC=0.641。结论 FIB 可作为一项反映 HSPN 患儿肾脏病理变化轻重的实验室检查指标，能反映肾脏病理分级的轻重，与肾小球硬化、球囊粘连等肾单位微观指标关系密切，可协助临床诊断和治疗。
Background?FibrinogenFIBis often elevated in children with Henoch Schonlein purpuric nephritis HSPNbut the correlation between FIB and renal lesions has been less studied. Objective?To explore the correlation between FIB in children with HSPN and the International Study Group on Pediatric Kidney DiseaseISKDCpathology grading and micropathological changes in parts of renal unitsand to clarify whether FIB can assess the severity of renal injury in children with HSPN. Methods?In total922 children with HSPN who were hospitalized in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine in the pediatric nephrology ward and underwent kidney biopsy at the same time from December 2017 to December 2022 were collectedand the clinical informationFIB and renal pathological information during renal biopsy were summarizedand based on the FIB levelthe children were categorized into group Alow4.98 g/L. The correlation between FIB and ISKDC pathological grades glomerular mesangial hyperplasia ratioand the crescent ratio was investigated by Spearman rank correlation analysisand the prediction of FIB on the micropathological changes of renal units was analyzed by the subject's work characteristicROCcurve. Results?Among 922 children with HSPN who had undergone renal biopsythe FIB was3.481.01g/L. 113 cases in group A had a low FIB rate of 12.26%734 cases in group B had a standardized FIB rate of 79.61%and 75 cases in group C had a high FIB rate of 8.13%. The ISKDC pathology classification was type a in 173 cases18.76%type b in 29 cases3.15% 466 cases50.54%of type a232 cases25.16%of type band 22 cases2.39%of type and aboveincluding 2 cases of type a18 cases of type band 2 cases of type . The results of the Spearman's rank correlation analysis showed that the FIB and the grouping of the FIB of the children with HSPN were positively related to the renal pathology ISKDC gradingrs=0.146P<0.001rs=0.129P<0.001. 91198.9% of 922 children with HSPN were mesangial proliferative and 65571.04%had crescentic hyperplasia. Spearman rank correlation analysis showed a weak positive correlation between FIB and FIB subgroups and the rate of mesangial hyperplasiars=0.092P=0.005rs=0.096P=0.003and a positive correlation with the rate of crescentic bodiesrs=0.132P<0.001rs=0.83P=0.012. 922 children with HSPN had glomerular acute lesions in 763 cases82.75%acute chronic lesions in 97 cases10.52%and chronic lesions in 62 cases 6.73%. In additionFIB gradually increased with the nature of the glomerular lesions from acute to chronicrs=0.145 P<0.001. At the same timewith renal biopsyseveral index lesionscrescent bodymesangial hyperplasiaglomerular sclerosisballoon adhesiontubulinflammation or regenerationtubular cell particle degenerationtubular interstitial edema tubular inflammatory cell infiltrationtubular atrophytubulointerstitial fibrosistubular lumenand renal interstitial vascular abnormalitiesin the comparison of the children's FIB were significantly correlatedP<0.05.The ROC curves showed that the FIB had the highest sensitivity for glomerulosclerosissensitivity=0.900specificity=0.303and the optimal cutoff value for FIB was 2.835 mg/Lthe area under the ROC curveAUCof FIB for the positive prediction of tubulointerstitial fibrosis=0.623and that of FIB for the reverse prediction of tubulointerstitial cellular granulomatous degeneration=0.641. Conclusion?FIB can be used as a laboratory index reflecting the severity of renal pathological changes in patients with HSPN can indicate the severity of renal pathological gradingis closely related to irreversible lesions according to renal microscopic indicators such as glomerular sclerosis and balloon adhesionand can be used to assist in clinical diagnosis and treatment.
黄岩杰、吴瑞红、杨晓青、丁樱、徐炎、代彦林、高敏、韩姗姗
10.12114/j.issn.1007-9572.2023.0734
儿科学临床医学内科学
肾炎紫癜性肾炎病理分级凝血指标纤维蛋白原
黄岩杰,吴瑞红,杨晓青,丁樱,徐炎,代彦林,高敏,韩姗姗.紫癜性肾炎患儿纤维蛋白原与国际小儿肾脏病研究组病理分级及肾单位微观病变的关系研究[EB/OL].(2024-02-22)[2025-08-11].https://chinaxiv.org/abs/202402.00223.点此复制
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