IL-6和SAA在原发性肾病综合征复发患儿合并感染中的诊断价值
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摘要
目的:探讨白介素6(IL-6)和血清淀粉样蛋白A(SAA)对儿童原发性肾病综合征(PNS)复发合并感染的诊断价值。方法:78例PNS复发患儿分为三组,A组:PNS合并细菌感染42例,B组:PNS合并病毒感染24例,C组:非感染PNS复发患儿l2例。分别检测三组患儿的IL-6、SAA水平,并建立受试者工作曲线(ROC)评价IL-6和SAA对PNS合并细菌感染的诊断价值。结果:A组患儿IL-6、SAA阳性率(85.71%、71.43%)明显高于B组(0.00%、20.83%)和C组(16.67%、33.33%),差异有统计学意义(P<0.05)。IL-6的ROC曲线下面积(AUC)为0.899,SAA的AUC为0.56。IL-6截断点为10.71时,诊断PNS合并细菌感染的敏感度及特异性分别为85.7%和91.7%,Youden指数为0.774,阳性及阴性似然比分别为10.33和0.16。结论:检测SAA和IL-6可用于区分PNS合并细菌感染与PNS合并病毒感染和非感染;其中IL-6在PNS合并细菌感染时有较高的辅助诊断价值。
Objective: To investigate the diagnostic value of interleukin 6(IL-6) and serum amyloid protein A(SAA in relapse of primary nephrotic syndrome combined with infection in children. Methods: 78 children with relapse of primary nephrotic syndrome were divided into 3 groups: group A, 42 children with relapse of primary nephrotic syndrome combined bacterial infection; group B, 24 children with relapse of primary nephrotic syndrome combined viral infection; group C,12 children with relapse of primary nephrotic syndrome with non infection. The serum IL-6 level and SAA of children in 3 groups were respectively detected, and ROC curve were established to evaluate the diagnostic value of IL-6 and SAA in relapse of primary nephrotic syndrome combined with bacterial infection. Results: The positive rate of IL-6 and SAA(85.71%,71.43%) of children in group A were significantly higher than group B(0.00%, 20.83%) and group C(16.67%, 33.33%, P<0.05).The AUC of IL-6 and SAA was respectively 0.899 and 0.56. When the cutoff point of IL-6 was 10.71, the sensitivity,specificity, Youden index, positive likelihood ratio and negative likelihood ratio of IL-6 in diagnosing primary nephrotic syndrome combined with bacterial infection were 85.7%, 91.7%, 0.774, 10.33 and 0.16. Conclusions: Detection of SAA and IL-6 can be used to distinguish primary nephrotic syndrome combined bacterial infection from with viral infection and non infection. Moreover, IL-6 has a higher diagnostic value in primary nephrotic syndrome combined with bacterial infection.
Objective: To investigate the diagnostic value of interleukin 6(IL-6) and serum amyloid protein A(SAA in relapse of primary nephrotic syndrome combined with infection in children. Methods: 78 children with relapse of primary nephrotic syndrome were divided into 3 groups: group A, 42 children with relapse of primary nephrotic syndrome combined bacterial infection; group B, 24 children with relapse of primary nephrotic syndrome combined viral infection; group C,12 children with relapse of primary nephrotic syndrome with non infection. The serum IL-6 level and SAA of children in 3 groups were respectively detected, and ROC curve were established to evaluate the diagnostic value of IL-6 and SAA in relapse of primary nephrotic syndrome combined with bacterial infection. Results: The positive rate of IL-6 and SAA(85.71%,71.43%) of children in group A were significantly higher than group B(0.00%, 20.83%) and group C(16.67%, 33.33%, P<0.05).The AUC of IL-6 and SAA was respectively 0.899 and 0.56. When the cutoff point of IL-6 was 10.71, the sensitivity,specificity, Youden index, positive likelihood ratio and negative likelihood ratio of IL-6 in diagnosing primary nephrotic syndrome combined with bacterial infection were 85.7%, 91.7%, 0.774, 10.33 and 0.16. Conclusions: Detection of SAA and IL-6 can be used to distinguish primary nephrotic syndrome combined bacterial infection from with viral infection and non infection. Moreover, IL-6 has a higher diagnostic value in primary nephrotic syndrome combined with bacterial infection.
引文
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[2]Wang Y,Huang H,Sun R,et al.Serum amyloid a induces M2b-like macrophage polarization during liver inflammation[J].Oncotarget,2017,8(65):109238-109246.
[3]De Buck M,Gouwy M,Wang JM,et al.Structure and Expression of Different Serum Amyloid A(SAA)Variants and their Concentration-Dependent Functions During Host Insults[J].Curr Med Chem,2016,23(17):1725-1755.
[4]杨霁云,白克敏.小儿肾脏病基础与临床[M].北京:人民卫生出版社,2000:164.
[5]中华医学会儿科学分会肾脏病学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(10):729-734.
[6]Dogra S,Kaskel F.Steroid-resistant nephrotic syndrome:a persistent challenge for pediatric nephrology[J].Pediatr Nephrol,2017,32(6):965-974.
[7]Kamei K,Ogura M,Sato M,et a1.Risk factors for relapse and long-term outcome in steroid-dependent nephrotic syndrome treated with rituximab[J].Pediatr Nephrol,2016,31(1):89-95.
[8]Esfahani ST,Madani A,Asgharian F,et a1.Clinical course and outcome of children with steroid-sensitive nephrotic syndrome[J].Pediatr Nephrol,2011,26(7):1089-1093.
[9]耿红莲,仲人前.血清淀粉样物质A研究进展[J].现代检验医学杂志,2010,25(4):10-12.
[10]Eklund KK,Niemi K,Kovanen PT.Immune functions of serum amyloid A[J].Crit Rev Immunol,2012,32(4):335-348.
[11]Ng A,Tam WW,Zhang MW,et al.IL-1β,IL-6,TNF-αand CRPin Elderly Patients with Depression or Alzheimer’s disease:Systematic Review and Meta-Analysis[J].Sci Rep,2018,8(1):12050.
[12]李雯,徐永健,魏华平.白介素-4和白介素-6在慢性阻塞性肺病肺组织中的表达[J].中国组织化学与细胞化学杂志,2001,10(4):425-428.