中国现代医学杂志2026，Vol.36Issue(11)：8-16,9.DOI:10.3969/j.issn.1005-8982.2026.11.002
基于血清补体C3与CHI3L1构建紫癜性肾炎高危患儿的预测模型及防治策略
Development of a predictive model and prevention strategy for high-risk children with Henoch-Schönlein purpura nephritis based on serum complement C3 and CHI3L1
摘要
Abstract
Objective To investigate the predictive value of complement C3 and chitinase-3-like protein 1(CHI3L1)in the prognosis of henoch-schönlein purpura nephritis(HSPN)in children,and to construct a combined predictive model and prevention strategy,thereby providing a basis for the early identification and treatment of high-risk pediatric patients.Methods A total of 100 pediatric HSPN patients were enrolled at a 1:1 ratio to Beijing Anzhen Nanchong Hospital of Capital Medical University(Nanchong Central Hospital)from January 2020 to December 2024 were retrospectively analyzed.Based on follow-up outcomes,patients were divided into a good prognosis group and a poor prognosis group(n=50 each).Data including age of onset,laboratory parameters,and clinical features were collected.Univariate and multivariate logistic regression analyses were used to identify prognostic factors.The receiver operating characteristic(ROC)curve,precision-recall(PR)curve,and model quality score were employed to evaluate the predictive performance of individual markers and the combined model.Results No significant differences were observed between the good-and poor-prognosis groups regarding sex,age at onset,disease duration,macroscopic hematuria,abdominal or joint pain,anemia,hypoalbuminemia,RAS inhibitor or immunosuppressive therapy,and cholesterol levels(P>0.05).The poor-prognosis group showed higher ISKDC grading,neutrophil count,WBC,RDW,D-dimer,proteinuria,NAG/UCr,CRP,CHI3L1,PLT,frequency of purpura≥3 times,rash duration≥2 weeks,hyperuricemia rate,and longer interval from kidney involvement to biopsy,but lower complement C3,and shorter rash-to-kidney involvement interval(P<0.05).Multivariate logistic regression identified elevated ISKDC grading[ÔR=2.339(95%CI:1.248,4.385)],neutrophil count[ÔR=2.955(95%CI:1.077,4.508)],CHI3L1[ÔR=1.353(95%CI:1.109,1.651)],and decreased complement C3[ÔR=0.002(95%CI:0.000,0.338)]as independent risk factors for poor prognosis(P<0.05).ROC analysis showed AUCs of 0.706(ISKDC),0.813(neutrophil),0.728(C3),0.819(CHI3L1),and 0.937 for the combined model,with sensitivities of 76.0%,78.0%,84.0%,78.0%,88.0%,and specificities of 56.0%,76.0%,56.0%,84.0%,94.0%.Internal validation confirmed good calibration(AUC=0.906,P>0.05).Conclusion ISKDC grade,NEU,CHI3L1,and complement C3 are potential biomarkers for predicting prognosis in HSPN children.The combined predictive model based on these indicators demonstrates strong discriminatory ability and clinical applicability,enabling effective identification of high-risk patients.Based on the model assessment results,individualized intervention strategies including early corticosteroid pulse therapy,immunomodulation,combined antifibrotic therapy,and dynamic monitoring of relevant indicators are proposed to optimize the prognostic management of HSPN children.关键词
紫癜性肾炎/补体C3/人软骨糖蛋白39/ISKDC分级/预后/预测模型Key words
henoch-schönlein purpura nephritis/complement C3/chitinase-3-like protein 1/ISKDC grade/prognosis/predictive model分类
医药卫生引用本文复制引用
白静,丁小燕,刘琦..基于血清补体C3与CHI3L1构建紫癜性肾炎高危患儿的预测模型及防治策略[J].中国现代医学杂志,2026,36(11):8-16,9.基金项目
四川省基层卫生发展研究科研项目(SWFZ-22-Y-18) （SWFZ-22-Y-18）
