Clinical Significance of NLR Ratio, D-dimer and MALB in Children with Anaphylactoid Purpura
NLR比值、D-二聚体、MALB在儿童过敏性紫癜中的临床意义

摘要

目的 探讨外周血中性粒细胞与淋巴细胞的比值（Neutrophil to Lymphocyte ratio ，NLR）、尿微量球蛋白（MALB）、D-二聚体在过敏性紫癜患儿中的临床意义。方法 将我院儿科2017年12月至2022年12月收治的100例过敏性紫癜患儿的资料：白细胞、中性粒细胞、淋巴细胞、单核细胞、CRP、血小板、D-二聚体、血肌酐、尿微量蛋白、NLR的计数进行回顾性分析，用logistic回归分析肾损害的危险因素，用ROC曲线对肾损害各指标的临床效能进行评估。结果 WBC、NEU、PLT、NLR、MALB、D-二聚体在HSP组高于健康对照组，HSPN组高于HSP非肾损害组，差异均有统计学意义（P<0.05）。Logistic回归分析结果NLR（OR=1.051，P<0.015）、MALB （OR=3.897，P<0.05）、D-二聚体（OR=1.074，P<0.05）为过敏性紫癜肾损害的危险因素。 ROC曲线显示，NLR、MALB、D-二聚体、及三者联合检测的AUC 分别为0.859、0886、0.756、0.897，单个指标中MALB的AUC面积最大，其特异性为78.7%，敏感性为 84.0%；三项联合检测AUC面积大于单个指标，敏感度为 86.5%，特异度为77.5%。结论 NLR、MALB、血D-二聚体是HSPN的独立危险因素，对HSP发生肾损害的早期评估中，MALB价值最高，三项指标联合检测意义大于单个指标。

Abstract

Objective To explore the clinical significance of peripheral blood neutrophil to lymphocyte ratio (NLR), Urinary Micro-globulin (MALB) and D-dimer in children with anaphylactoid purpura.
Methods The data of 100 children with henoch-schonlein purpura admitted from December 2017 to December 2022 in our department of pediatrics were retrospectively analyzed, including the counts of white blood cells, neutrophils, lymphocytes, monocytes, CRP, platelets, D-dimers, serum creatinine, urinary micro-protein and NLR. The risk factors of renal damage were analyzed by logistic regression, and the clinical efficacy of various indicators of renal damage was evaluated by ROC curve.
Results WBC, NEU, PLT, NLR, MALB, D-dimer in HSP group were higher than those in healthy control group, and HSPN group was higher than those in HSP non-renal damage group, with statistical significance (P<0.05). Logistic regression analysis showed that NLR (OR=1.051, P<0.015), MALB (OR=3.897, P<0.05),D-dimer(OR=1.074,P<0.05),were risk factors for renal damage in anaphylactoid purpura. The ROC curve showed that the AUC detected by NLR, MALB, D-dimer and their combination were 0.859、0886、0.756、0.897， respectively. Among the single indicators, the AUC area of MALB was the largest, with its specificity of 78.7% and sensitivity of 84.0%; The AUC area of three combined tests was larger than that of a single index, with sensitivity of86.5% and specificity of 77.5%.
Conclusion  : NLR, MALB and blood D-dimer are independent risk factors for HSPN. In the early assessment of renal damage caused by HSP, MALB has the highest value, and the combined detection of the three indicators is more significant than a single indicator.