The relationship between red cell distribution width and the risk of Henoch-Schönlein purpura nephritis

Blood routine examination: a simple way for differential diagnosis of immunoglobulin A vasculitis with abdominal involvement and appendicitis in children

To explore the value of blood routine examination indexes in the differential diagnosis of immunoglobulin A vasculitis (IgAV) with abdominal involvement and appendicitis in children. Forty-seven patients with IgAV and abdominal involvement, 95 cases with appendicitis, and 48 healthy children were enrolled in this study. Demographic and laboratory data were retrospectively recorded from medical files. The levels of serum percentage of lymphocytes (LYM%), percentage of eosinophils (E%), red cell volume distribution width (RDW) and platelet (PLT) count were higher, while blood cells (WBC) count, percentage of neutrophils (N%), percentage of monocytes (M%), mean platelet volume (MPV), platelet distribution width and C-reactive protein were lower in the group of IgAV with abdominal involvement compared to appendicitis group (P < 0.05). Multivariate logistic regression analysis showed LYM% (odds ratio (OR) = 1.34, P = 0.001) and RDW (OR = 2.96, P = 0.045) were independent risk factors for IgAV with abdominal involvement. N% (OR = 1.270, P = 0.006) and MPV (OR = 51.15, P = 0.042) were independently associated with appendicitis. Using receiver operating characteristic analysis, the optimal cut-off values (sensitivity and specificity) respectively were 42.17% (95.7%, 100.0%) for LYM%, 12.65% (83.0%, 83.2%) for RDW, 61.5% (91.6%, 97.9%) for NE% and 10.1fL (78.9%, 75.4%) for MPV, with the AUC values of 0.989, 0.881, 0.985, 0.810, respectively. Blood routine examination indices, especially the N%, LYM%, RDW, and MPV, can be used for simple differential diagnosis of IgAV with abdominal involvement and appendicitis.

Predictive Value of Laboratory Indexes on Renal Involvement in Children with Henoch-Schönlein Purpura

Objective

Henoch-Schönlein purpura (HSP) is the most common vasculitis in children. Renal involvement is the main long-term complication of HSP, and presently there is no way to predict which children may have irreversible renal damage from the outset. This study aimed to explore the prediction value of laboratory indexes on renal involvement in children with HSP, which could help the early identification and intervention.

Methods

Children with HSP hospitalized at the First Affiliated Hospital of Henan University of Chinese Medicine from June 2019 to December 2020 were included. The demographic findings, clinical features, laboratory findings including blood routine examination, serum immunoglobulin, complement, T cell subsets levels, liver and kidney function, coagulation function were recorded. Laboratory indexes were analyzed, logistic regression analysis was performed to identify the independent predictors in HSP patients with renal involvement, and receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes, as well as the efficacy of combined diagnosis.

Results

The study included 146 HSP patients, among them, 50 patients (34.2%) had renal involvement. Age, platelet distribution width (PDW), CD3⁺ and fibrinogen (FIB) were positively correlated with renal involvement, while the levels of Immunoglobulin G (IgG), C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) were negatively correlated with renal involvement. The area under the ROC Curve (AUC) of these biomarkers ranged from 0.6284 to 0.7009, and among the combinations, a combination of NLR, CRP, CD3⁺, FIB, PDW, IgG and age had the best AUC value (0.9774).

Conclusion

Age, PDW, CD3⁺, FIB, CRP, NLR and IgG were prediction indexes for renal involvement in HSP patients, and these indexes can be combined appropriately to improve the diagnostic efficacy.

Imbalanced Th17/Treg in peripheral blood of adult patients with immunoglobulin A vasculitis nephritis

Introduction

Adult immunoglobulin A vasculitis nephritis (IgAVN) was observed to be more severe than the disease in children because it tended to result in a poor prognosis. The present study analyzed the Th17/Treg cell axis in peripheral blood of adult IgAVN patients, aiming to provide new immunological viewpoints for the pathogenesis of adult IgAVN.

Material and methods

Th17 cell and Treg cell frequencies in peripheral blood of healthy subjects (n = 13) and adult IgAVN patients (n = 12) were analyzed by flow cytometry. Foxp3 mRNA in peripheral blood of healthy subjects and adult IgAVN patients was detected by RT-PCR. Interleukin (IL)-17 and IL-10 in peripheral blood serum of healthy subjects and adult IgAVN patients were examined by ELISA.

Results

The percentages of CD4⁺ Th17⁺ cells in peripheral blood of healthy subjects and adult IgAVN patients were 2.65 ±1.55% and 4.37 ±1.68% respectively. The percentages of Treg cells in peripheral blood of healthy subjects and adult IgAVN patients were 6.44 ±2.90% and 3.91 ±1.94% respectively. The ratio of Th17/Treg in adult IgAVN patients was significantly higher than that of healthy subjects (p = 0.0030). Meanwhile, the Foxp3 mRNA expression of adult IgAVN patients was significantly lower than that of healthy subjects. There was a significant difference in the ratio of IL-17/IL-10 between healthy subjects and adult IgAVN patients (p < 0.0001). A significant correlation between red blood cell distribution width (RDW) and the ratio of Th17/Treg in adult IgAVN patients was observed in Spearman correlation analysis (r = 0.6970, p = 0.0145).

Conclusions

Imbalanced Th17/Treg contributed to the complex pathogenesis of adult IgAVN.

Assessment of the association between red blood cell distribution width and disease activity in patients with systemic vasculitis

The present study aimed to investigate whether red blood cell distribution width (RDW) could serve as a marker for estimating disease activity in patients with systemic vasculitis (SV). A total of 287 patients with SV and 64 age- and sex-matched healthy controls (HCs) were included in the present study. Biochemical indicators and hematologic parameters were evaluated in patients with SV and the HCs. Disease activity was assessed on the basis of the Birmingham Vasculitis Activity Score (BVAS). RDW was significantly elevated in patients with SV compared with HCs (P<0.05). A similar result was obtained for the comparison of patients with various disease states, active vs. inactive (P<0.05). RDW was significantly increased in patients with kidney injury compared with patients without kidney injury (P<0.05). The correlation analysis indicated that there were positive correlations between RDW and BVAS, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, white blood cells and serum creatinine (Scr; all P<0.05). In addition, there was a significant negative correlation between RDW and hemoglobin levels (P<0.05). Multivariate logistic regression analysis indicated that RDW was independently correlated with patients with active SV. The combined diagnosis of RDW and Scr indicated that the sensitivity and specificity were 68.6 and 88.9%, respectively, in terms of assessing disease activity in patients with SV. Therefore, the present study suggested that RDW may serve as a useful index for estimating disease activity and kidney injury in patients with SV. Moreover, the combination of RDW and Scr may be more effective than RDW alone when assessing the risk of disease activity in patients with SV.

British Journal of Biomedical Science in 2018: what have we learned?

In 2018 the British Journal of Biomedical Science published one guideline (in reproductive science) and 40 research articles in the various disciplines the comprise biomedical science. The latter were 24 original articles and 16 'In Brief' short reports. Of these, 23 are of note to only one of the sub-disciplines (seven each to biochemists and microbiologists, six to cell pathologists, and one each to cytologists, immunologists and reproductive scientists). Reflecting the increasing complexity of laboratory science, thirteen papers crossed one boundary (three papers each relevant to biochemists and immunologists, and to haematologists and biochemists), whilst four papers were relevant to three or more disciplines. Indeed, biochemical techniques were used in 18 papers, microbiological techniques in 9, whilst histopathology was relevant to 11 papers. Notably, 20 papers used techniques in chromosome analysis and molecular genetics. The present report will summarise key aspects of these publications that are of greatest relevance to laboratory scientists.