EB病毒感染相关性紫癜肾炎后急性肾损伤中医证型分布情况及相关指标联合检测的诊断价值  

Diagnostic Value of TCM Syndromes and Related Indexes Combined Monitoring in Children with Acute Kidney Injury after Epstein-Barr Virus Infection-Associated Purpura Nephritis

作　　者：王彩芳[1] 么鑫 蔡花 张菂[1] 黄翠影 梁晓亮[1] 陈瑞珊 海冬[1] WANG Caifang;YAO Xin;CAI Hua;ZHANG Di;HUANG Cuiying;LIANG Xiaoliang;CHEN Ruishan;HAI Dong(Tangshan Kailuan General Hospital,Tangshan 063000,Hebei,China)

机构地区：[1]唐山市开滦总医院,河北唐山063000

出　　处：《中华中医药学刊》2021年第12期251-254,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：河北省卫生与健康委员会重点科技研究计划(20191335)。

摘　　要：目的分析EB病毒感染相关性紫癜肾炎后急性肾损伤患儿中医证型分布情况及尿液中L-FABP、NGAL、IL-8联合检测的诊断价值。方法为前瞻性病例对照研究,选取医院收治的102例EB感染相关性紫癜性肾炎患儿作为研究对象,根据是否并发急性肾损伤,分为对照组(无急性肾损伤)与观察组(并发急性肾损伤),统计两组中医证型分布情况,检测6h尿L-FABP、NGAL、IL-8水平,并对结果进行分析。结果(1)中医证型分布:对照组患儿前三位中医证型为风热伤络型(36.2%,21/58)、血热妄行型(24.1%,14/58)、湿热内蕴型(19.0%,11/58),观察组为湿热内蕴型(38.6%,17/44)、风热伤络型(20.5%,9/44)、血热妄行型(18.18%,8/44)观察组中湿热内蕴型患儿明显高于对照组,差异存统计学意义(P<0.05);(2)临床指标方面:紫癜性肾炎后急性肾损伤患儿的血SCr、IL-8、尿NGAL及尿KIM-1明显高于对照组,GFR显著低于对照组,差异均存统计学意义(P<0.01);(3)诊断效能比较:患儿6 h尿KIM-1、尿NGAL及IL-8联合检测效能最高,明显高于其他单一指标的诊断效能,灵敏度为90.91%、特异度为91.38%,阳性预测值为88.89%,阴性预测值为92.98%;(4)相关性分析:血SCr与6 h尿KIM-1、尿NGAL、IL-8呈正相关(P<0.01),GFR与6 h尿KIM-1、尿NGAL、IL-8呈负相关(P<0.01)。结论EB病毒感染相关性紫癜肾炎后急性肾损伤患儿以湿热内蕴为主要中医证型,而尿液KIM-1、尿NGAL及IL-8的联合检测对其早期诊断具有重要意义,可在临床中应用。Objective To analyze the distribution of TCM syndromes in children with acute renal injury after Epstein-Barr(EB)virus infection associated purpura nephritis and the diagnostic value of combined detection of L-FABP,NGAL and IL-8 in urine.Method This study was a prospective case-control study.A total of 102 children with EB infection associated purpura nephritis treated in our hospital were selected as the research object.According to whether the children were complicated with acute renal injury,they were divided into control group(no acute renal injury)and observation group(complicated with acute renal injury).The distribution of TCM syndromes in the two groups were counted,and the levels of L-FABP and NGAL in urine and IL-8 in 6 h were detected and analyzed.Results(1)Distribution of TCM syndrome types:The top three TCM syndrome types of children in the control group were wind-heat injuring collaterals(36.2%,21/58),bleeding due to blood-heat(24.1%,14/58),damp-heat accumulation(19.0%,11/58),and those in the observation group were damp-heat accumulation(38.6%,17/44),wind-heat injuring collaterals(20.5%,9/44)and bleeding due to blood-heat(18.18%,8/44).The children with damp-heat accumulation in the observation group were significantly higher than those in the control group(P<0.05)(2)Clinical indicators:The serum levels of SCR and IL-8 and levels of NGAL and KIM-1 in urine in children with acute kidney injury after purpura nephritis were significantly higher than those in the control group,and the GFR was significantly lower than that in the control group(P<0.01).(3)Comparison of diagnostic efficacy:The combined detection efficiency of KIM-1 and NGAL in urine and IL-8 in 6 h was the highest,which was significantly higher than that of other single indicators,with sensitivity of 90.91%,specificity of 91.38%,positive predictive value of 88.89%and negative predictive value of 92.98%.(4)Correlation analysis:There was a positive correlation between serum SCR and IL-8 and KIM-1 and NAGL in 6 h urine(P<0.01),and a negative c

关 键 词：儿童 紫癜性肾炎 急性肾损伤 中医证型 临床指标 

分 类 号：R271.914.258[医药卫生—中西医结合]