广西医学

目的探讨肾主动脉血流动力学指标与尿微量白蛋白（UAlb）在过敏性紫癜（HSP）患儿早期肾损害中的应用价值。方法选择97例HSP患儿作为HSP组，根据是否发生早期肾损害分为无肾损害组（n=53）和早期肾损害组（n=44），另选择75例健康儿童作为对照组。检测HSP组的尿β2⁃微球蛋白（β2⁃MG）、24 h尿蛋白定量、血常规、血生化指标，检测HSP组和对照组的UAlb、肾主动脉血流动力学指标［肾主动脉血流峰值加速时间（AT）、收缩期峰值血流速度（Vs）、舒张末期峰值血流速度（Vd）和血管阻力指数（RI）］。比较HSP组与对照组、无肾损害组与早期肾损害组的上述指标，分析HSP患儿发生早期肾损害的影响因素，采用受试者工作特征（ROC）曲线分析肾主动脉血流动力学指标和UAlb单独及联合预测HSP早期肾损害的效能。结果 HSP组Vs、Vd低于对照组，AT、RI、UAlb长于或高于对照组（P<0.05）。早期肾损害组Vs、Vd低于无肾损害组，AT、RI、UAlb长于或高于无肾损害组（P<0.05）。皮疹反复发作、高RI、高UAlb是HSP患儿发生早期肾损害的危险因素，高Vs、高Vd是HSP患儿发生早期肾损害的保护因素（P<0.05）。UAlb、Vs、Vd、RI单独预测HSP患儿发生早期肾损害的曲线下面积分别为0.783、0.746、0.653、0.780，四者联合预测HSP患儿发生早期肾损害的曲线下面积为0.913，高于单个指标的曲线下面积（P<0.05）。结论 HSP患儿发生早期肾损害的Vs、Vd降低，AT、RI、UAlb增高，皮疹反复发作、高RI、高UAlb的HSP患儿发生早期肾损害的风险较高，高Vs、高Vd的HSP患儿发生早期肾损害的风险较低，肾主动脉血流动力学指标联合UAlb预测HSP早期肾损害的效能较高。

Objective To investigate the application value of renal aorta hemodynamic indices and urine microalbumin (UAlb) for early renal damage in children with Henoch⁃Schönlein purpura (HSP). Methods A total of 97 HSP children were selected as HSP group, and they were divided into non⁃renal damage group (n=53) or early renal damage group (n=44) according to the presence of early renal damage; in addition, another 75 healthy children were selected as control group. The urinary β2⁃microglobulin (β2⁃MG), 24⁃hour urine protein quantitation, blood routine examination, blood biochemical indices of the HSP group were detected. The UAlb, renal aorta hemodynamic indices with respect to renal aorta peak acceleration time (AT), systolic peak velocity (Vs), end⁃diastolic peak velocity (Vd), and vascular resistance index (RI) were detected in the HSP and control groups. The aforementioned indices were compared between the HSP group and the control group, and between the non⁃renal damage group and the early renal damage group. The influencing factors for the occurrence of early renal damage in HSP children were analyzed, and the receiver operating characteristic (ROC) curve was employed to analyze the efficiency of renal aorta hemodynamic indices and UAlb for alone and jointly predicting HSP early renal damage. Results The HSP group exhibited lower Vs and Vd, whereas longer AT and higher RI and UAlb as compared with the control group (P<0.05). The early renal damage group yielded lower Vs and Vd, whereas longer AT and higher RI and UAlb as compared with the non⁃renal damage group (P<0.05). Recurrent rash, high RI, high UAlb were the risk factors for the occurrence of early renal damage in HSP children, while high Vs, high Vd were the protective factors for the occurrence of early renal damage in HSP children (P<0.05). Areas under the curve of UAlb, Vs, Vd, and RI for alone predicting the occurrence of early renal damage in HSP children were 0.783, 0.746, 0.653, and 0.780, respectively, and area under the curve of the combination of the four for jointly predicting the occurrence of early renal damage in HSP children was 0.913, which was higher than area under the curve of any single index (P<0.05). Conclusion HSP children with early renal damage present as decreased Vs and Vd, while increased AT, RI and UAlb. HSP children with recurrent rash, high RI and UAlb have relatively high risk of suffering from early renal damage, whereas HSP children with high Vs and Vd have relatively low risk of suffering from early renal damage. Renal aorta hemodynamic indices combined with UAlb for predicting HSP early renal damage exerts relatively high efficiency.