原发性肾病综合征患儿血清CTLA4、S100A12水平与病情、预后的关系  

Analysis of the relationship between serum CTLA4,S100A12 levels and disease condition and prognosis in children with primary nephrotic syndrome

作　　者：吴琛 董晨 庄亚飞 臧瑶瑶 梁娟 关凤军 Wu Chen;Dong Chen;Zhuang Yafei;Zang Yaoyao;Liang Juan;Guan Fengjun(Department of Pediatrics,Affiliated Hospital of Xuzhou Medical University,Jiangsu,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院儿科,江苏徐州221000

出　　处：《疑难病杂志》2025年第2期203-208,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金项目(82173630);徐州市科技计划社发重点项目(KC21172)。

摘　　要：目的探讨原发性肾病综合征(PNS)患儿血清细胞毒性T淋巴细胞相关抗原4(CTLA4)、S100钙结合蛋白A12(S100A12)水平与病情、预后的关系。方法回顾性选取2019年6月—2021年6月徐州医科大学附属医院儿科收治的PNS患儿129例为PNS组。根据不同病情将患儿分为单纯PNS亚组69例和肾炎型PNS亚组60例;根据治疗后随访3年(失访2例)预后情况将患儿分为预后不良亚组23例和预后良好亚组104例。另选取同期医院健康体检儿童108例为健康对照组。采用酶联免疫吸附法检测血清CTLA4、S100A12水平;Pearson法分析PNS患儿血清CTLA4、S100A12水平与血清Alb水平、肾功能指标的相关性;多因素Logistic回归分析PNS患儿预后不良的影响因素;受试者工作特征(ROC)曲线评价血清CTLA4、S100A12水平对PNS患儿预后不良的预测价值。结果PNS组血清CTLA4水平低于健康对照组,血清S100A12水平高于健康对照组(t/P=22.138/<0.001、17.374/<0.001);肾炎型PNS亚组血清S100A12、BUN、SCr和24 h尿蛋白水平高于单纯PNS亚组,血清CTLA4、Alb水平低于单纯PNS亚组(t/P=11.092/<0.001、7.832/<0.001、7.379/<0.001、8.090/<0.001、14.359/<0.001、7.455/<0.001)。Pearson相关性分析显示,PNS患儿血清CTLA4水平与Alb水平呈正相关,与BUN、SCr、24 h尿蛋白水平呈负相关(r/P=0.464/0.001、-0.365/0.012、-0.328/0.019、-0.507/<0.001);血清S100A12水平与BUN、SCr、24 h尿蛋白水平呈正相关,与Alb水平呈负相关(r/P=0.286/0.031、0.307/0.023、0.427/0.003、-0.338/0.009)。预后不良亚组肾炎型PNS比例、BUN、SCr、24 h尿蛋白、S100A12水平高于预后良好亚组,血清Alb、CTLA4水平低于预后良好亚组(χ^(2)/t/P=10.841/0.001、6.397/<0.001、2.644/0.009、11.690/<0.001、6.834/<0.001、5.558/<0.001、3.874/<0.001)。肾炎型PNS、S100A12高是PNS患儿预后不良的独立危险因素[OR(95%CI)=2.236(1.211~4.131)、1.887(1.114~3.197)],CTLA4高是独立保护因素[OR(95%CI)=0.439(0.221~0.877)];血清CTLA4�Objective To investigate the relationship between serum levels of cytotoxic T-lymphocyte antigen-4(CTLA4)and S100 calcium-binding protein A12(S100A12)and the condition and prognosis of children with primary nephrotic syndrome(PNS).Methods A total of 129 children with PNS admitted to the Department of Pediatrics,Affiliated Hospital of Xuzhou Medical University from June 2019 to June 2021 were retrospectively selected as the PNS group.According to different conditions,the children were divided into simple PNS subgroup(69 cases)and nephritis PNS subgroup(60 cases);According to the prognosis of 3 years after treatment,the children were divided into poor prognosis subgroup(23 cases)and good prognosis subgroup(104 cases).108 healthy children were selected as healthy control group.The levels of serum CTLA4 and S100A12 were detected by enzyme-linked immunosorbent assay.Pearson method was used to analyze the correlation between serum CTLA4,S100A12 levels and serum Alb levels,renal function indexes in children with PNS.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in children with PNS.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CTLA4 and S100A12 levels for poor prognosis in children with PNS.Results The serum CTLA4 level in the PNS group was lower than that in the healthy control group,and the serum S100A12 level was higher than that in the healthy control group(t/P=22.138/<0.001,17.374/<0.001);The levels of serum S100A12,BUN,SCr and 24 h urine protein in the nephritis PNS subgroup were higher than those in the simple PNS subgroup,and the levels of serum CTLA4 and Alb were lower than those in the simple PNS subgroup(t/P=11.092/<0.001,7.832/<0.001,7.379/<0.001,8.090/<0.001,14.359/<0.001,7.455/<0.001);Pearson correlation analysis showed that serum CTLA4 level in children with PNS was positively correlated with Alb level,and negatively correlated with BUN,SCr and 24 h urine protein level(r/P=0.464/0.001,-0.365/0.01

关 键 词：原发性肾病综合征 细胞毒性T淋巴细胞相关抗原4 S100钙结合蛋白A12 病情 预后 儿童 

分 类 号：R726.9[医药卫生—儿科]