Serum Levels Of ApoM And PAF In Children With Henoch-sch(?)nlein Purpura And Their Clinical Significance

Objective: By measuring the expression level of serum apolipoprotein M(apo M)and platelet activation factor(PAF)in children with Henoch-Sch?nlein purpura(HSP),to explore the significance of apo M and PAF expression in pediatric HSP and its clinical diagnosis and predicted prognostic value in pediatric HSP with inner organ involvement.Methods: A total of 55 children with Henoch-Sch?nlein purpura hospitalized in the Department of Taizhou People’s Hospital Pediatrics from October 2021 to December2022 were selected.By collecting clinical data of children with Henoch-Sch?nlein purpura,they were divided into groups with and without visceral involvement.The group with inner organ involvement included children with gastrointestinal damage and(or)renal damage,there were 25 cases.All of the remaining HSP children were included in the group without visceral involvement,there were 30 cases.In addition,blood samples were collected from 27 children with HSP during remission of disease.During the same period,41 children with physical examination in the child care department or pediatric endocrinology department of our hospital as the control group.Using enzyme-linked immunosorbent assay to test the serum levels of apo M and PAF in acute and remission of HSP,and analysing its clinical diagnosis and predicted prognostic value in pediatric HSP with inner organ involvement.Results: 1.(1)There was no significant difference between HSP group and control group in age,sex composition,platelet count,MPV and PDW(P>0.05).The leukocyte count,neutrophil% and neutrophil to lymphocyte ratio(NLR)were higher than the control group(P<0.001).However,the lymphocyte% in the HSP group decreased compared with the control group,which was statistically significant(P<0.001).(2)The neutrophil% and NLR level in the group with inner organ involvement were higher than the group without accompanying inner organ involvement,and the difference was significant(P<0.05).The lymphocyte%,Ig A and Ig G levels were higher in the group with inner organ involvement(P<0.05).There were no significant differences between the two groups in sex composition,age,leukocyte count,platelet count,MPV,PDW,C-reactive protein,erythrocyte sedimentation rate(ESR),D-dimer,C3,C4,and Ig M(P>0.05).2.(1)The apo M level was increased in the HSP group compared with the control group,and it was significantly different(P<0.001).PAF levels decreased in the HSP group compared with the control group(P<0.001).(2)The NLR level of the group with inner organ involvement,the group without inner organ involvement and control group decreased successively,and the difference among the three was statistically significant(P<0.05).The apo M levels in the group with inner organ involvement,without inner organ involvement group and control group were statistically significant(P<0.05).The PAF levels of the group with inner organ involvement,the group without inner organ involvement and control group were statistically significant(P<0.05).3.Children with HSP had decreased apo M levels in the remission period compared with the acute phase(P<0.001).Children with HSP had increased PAF levels in the remission period compared with the acute phase(P<0.001).4.While elevated levels of apo M was an independent risk factor for HSP with organ involvement(OR:1.017,95%CI:1.000-1.034,P<0.05),while elevated levels of Ig A was an independent protective factor for HSP with organ involvement(OR:0.393,95%CI:0.155-0.997,P<0.05).5.NLR value For HSP children with inner organ involvement,the ROC area under the ROC curve(AUC)was 0.719,the optimal cut-off value was 0.366,sensitivity was 60%,and specificity was 76.7%.Children with HSP with apo M diagnosis with inner organ involvement had the area under the ROC curve(AUC)of 0.668 with an optimal cutoff of 0.266,sensitivity of 40% and specificity of 86.7%.When NLR and apo M were combined to diagnose children with inner organ involvement,the area under the ROC curve(AUC)was 0.749,which was the highest prediction of inner organ involvement in HSP,with a sensitivity of 88% and a specificity of 53.3% in children.Conclusion: apo M and PAF are probably involved in the pathogenesis of HenochSch?nlein purpura,and the course of disease can be judged by the change of expression level;Elevated levels of apo M is a risk factor of HSP with inner organ involvement;the combined test of NLR and apo M has certain value for early diagnosis of HSP children with inner organ involvement.