血清CCL5、CCL13在儿童IgA血管炎早期肾损伤中的预测价值OA
Predictive Value of Serum CCL5 and CCL13 for Early Renal Injury in Children with Immunoglobulin A Vasculitis
目的 探讨 IgA 血管炎(IgA vasculitis,IgAV)患儿血清中趋化因子(C-C 基元)配体 5[che-mokine(C-C motif)ligand 5,CCL5]与趋化因子(C-C 基元)配体 13[chemokine(C-C motif)ligand 13,CCL13]在早期发生肾损伤中的预测价值.方法 选取2023 年1 月至2025 年3 月于中国人民解放军联勤保障部队第九四○医院接受治疗的267 例 IgAV 患儿作为研究对象,并根据是否发生肾损伤分为 IgA 血管炎性肾炎(immunoglobulin A vasculitis with nephritis,IgAVN)组(n=94)与IgAV 组(n=173).收集两组患儿的临床资料.采用酶联免疫吸附试验检测血清中 CCL5、CCL13 水平,Spearman 相关性分析明确 IgAVN 患儿血清 CCL5、CCL13 水平的相关性,比较CCL5、CCL13 水平与IgAVN 临床分型的关系,多因素Logistic 回归分析 IgAV 患儿早期发生肾损伤的危险因素,并基于此构建列线图模型.绘制 ROC 曲线、校准曲线及决策曲线以评估模型的预测效能.ROC 曲线分析血清中 CCL5、CCL13 水平在评估 IgAV 患儿早期发生肾损伤的预测价值.结果 与 IgAV 组相比,IgAVN 组年龄、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)均显著升高(P均<0.05).与 IgAV 组相比,IgAVN 组血清 CCL5、CCL13 水平均显著升高(P均<0.05).Spearman 相关性分析显示,IgAVN 组患儿血清 CCL5、CCL13 水平呈显著正相关(r=0.339,P<0.001).不同临床分型的 IgAVN 患儿血清 CCL5 和 CCL13 水平存在差异且随病情严重程度增加(P<0.05).多因素 Logistic 回归分析结果显示,年龄升高、NLR 升高、血清 CCL5 和 CCL13 水平升高均为 IgAV患儿早期发生肾损伤的独立危险因素.基于Logistic 回归分析结果构建的列线图模型预测效能显著,具有较好的临床应用潜力.ROC 曲线分析结果显示,血清中 CCL5、CCL13 水平能够作为诊断 IgAV 患儿早期发生肾损伤的有效指标.结论 血清 CCL5、CCL13 水平升高与 IgAV 患儿早期肾损伤密切相关,联合检测其水平对于评估早期发生肾损伤具有较高价值.
Objective To investigate the predictive value of serum chemokine(C-C motif)ligand 5(CCL5)and chemokine(C-C motif)ligand 13(CCL13)for early renal injury in chil-dren with IgA vasculitis(IgAV).Methods A total of 267 children with IgAV treated at the 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2023 to March 2025 were enrolled.According to the presence or absence of renal injury,they were divided into an IgA vasculitis with nephritis(IgAVN)group(n=94)and an IgAV-without-ne-phritis group(n=173).Clinical data were collected.Serum CCL5 and CCL13 levels were measured by enzyme-linked immunosorbent assay.Spearman correlation was used to evaluate the relationship between CCL5 and CCL13 in IgAVN patients.Differences in CCL5 and CCL13 among IgAVN clini-cal subtypes were compared.Multivariate logistic regression was performed to identify independent risk factors for early renal injury in children with IgAV,and a nomogram was constructed.ROC curves,calibration curves,and decision-curve analysis were used to assess the model's predictive performance.ROC curve analysis was also used to evaluate the diagnostic value of serum CCL5 and CCL13 for early renal injury.Results The IgAVN group showed significantly older age and higher neutrophil-to-lymphocyte ratio(NLR)than the IgAV group(both P<0.05).Serum CCL5 and CCL13 levels were also markedly elevated in the IgAVN group(both P<0.05).Spearman analysis revealed a significant positive correlation between serum CCL5 and CCL13 in IgAVN patients(r=0.339,P<0.001).CCL5 and CCL13 levels differed among IgAVN clinical subtypes and increased with disease severity(P<0.05).Multivariate logistic regression indicated that increased age,ele-vated NLR,and higher serum CCL5 and CCL13 levels were independent risk factors for early renal injury in children with IgAV.The nomogram based on these factors demonstrated good predictive per-formance and clinical utility.ROC curve analysis showed that serum CCL5 and CCL13 were effective biomarkers for diagnosing early renal injury in children with IgAV.Conclusion Elevated serum CCL5 and CCL13 levels are closely associated with early renal injury in pediatric IgAV pa-tients.Combined detection of these markers holds significant value for assessing the occurrence of early renal injury.
王飞;曾繁霞;赵晓云;梁玲;郭林梅
中国人民解放军联勤保障部队第九四○医院儿科 兰州市,730050中国人民解放军联勤保障部队第九四○医院儿科 兰州市,730050中国人民解放军联勤保障部队第九四○医院儿科 兰州市,730050中国人民解放军联勤保障部队第九四○医院儿科 兰州市,730050中国人民解放军联勤保障部队第九四○医院儿科 兰州市,730050
医药卫生
IgA血管炎IgA血管炎性肾炎CCL5CCL13肾损伤预测价值
immunoglobulin A vasculitisimmunoglobulin A vasculitis with nephritische-mokine(C-C motif)ligand 5chemokine(C-C motif)ligand 13renal inju-rypredictive value
《医学分子生物学杂志》 2026 (3)
285-293,9
甘肃省自然科学基金(No.22JR5RA011) This work was supported by a grant from the Natural Science Foundation of Ganshu(No.22JR5RA011).
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