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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。
Objective To investigate the clinical value of vascular cell adhesion molecule-1 (VCAM-1) in the prognosis of purpura nephritis (APN) in children with Henoch-Schonlein purpura (AP) without renal damage. Methods A total of 85 children with AP without early renal damage were enrolled in this study. The follow-up period was 2 years. According to the follow-up results, the study groups were divided into two groups: APN group (case group) and non-APN group (control group) , The clinical value of plasma VCAM-1 levels in the prognosis of APN with AP in the early stage without renal impairment was analyzed. Results Among 85 cases of cross-sectional study, 16 cases in the case group and 69 cases in the control group were significantly higher than those in the control group (Z = 2.716, P = 0.0066 <0.01) ROC) curve was 71.2% (95% confidence interval 0.603-0.805), suggesting that plasma VCAM-1 is of great importance in the diagnosis of APN without renal damage. According to the clinical significance and ROC curve, four cutoff points of plasma VCAM-1 were selected: 1670μg / L, 1870μg / L, 1980μg / L and 2110μg / L respectively. The sensitivities of VCAM-1 were 62.50%, 56.25%, 56.25% 43.75%; specificity were 59.42%, 89.86%, 94.20% and 95.65% respectively. Plasma VCAM-1 content of 1980μg / L can maximize the sensitivity and specificity, as the ideal cut-off point. Conclusions The detection of plasma VCAM-1 in AP children with early renal damage has an important clinical significance in the prognosis of APN. The best diagnostic cut-off point is 1980 μg / L.