Clinical value of red blood cell distribution width in children with Henoch-Schönlein purpura

doi:10.3877/cma.j.issn.1674-0785.2019.01.002

Abstract

Abstract:

Objective

To investigate the clinical value of red blood cell distribution width (RDW) in children with Henoch-Sch?nlein purpura (HSP).

Methods

The data of children with HSP who were hospitalized at the Department of Pediatrics of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2013 to May 2018 were collected. According to the presence of kidney damage or not, the patients were divided into a Henoch-Sch?nlein Purpura nephritis (HSPN) group and a HSP without nephritis (HSPWN) group. Healthy children were included as a control group. For children with HSP and healthy children as well as HSPN children, HSPWN children, and healthy children, red blood cell (RBC) count, platelet (PLT) count were compared between two groups using two-sample t-test and among three groups using one-way ANOVA. The Wilcoxon rank sum test was used for comparison of age, white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), red blood cell distribution width variation coefficient (RDW-CV), red blood cell distribution width standard deviation (RDW-SD), and platelet mean volume (MPV) between groups. The χ² test was used for comparison of gender between groups. The Kruskal-Wallis test was used for comparison between any two groups (pairwise comparisons were selected in the view). Correlation analysis between RDW-CV, RDW-SD, and other indicators in children with HSP was performed by Spearman rank correlation analysis.

Results

There were no significant differences between HSP children and healthy children in gender, age, MCV, PLT count, or MPV (P>0.05). Blood WBC count, RDW-CV, and RDW-SD were significantly higher in children with HSP than in healthy children (Z=-6.838, P<0.001; Z=-5.437, P<0.001; Z=-4.681, P<0.001), while RBC count, Hb, and Hct were significantly lower in children with HSP than in healthy children (t=-2.701, P=0.008; Z=-4.396, P<0.001; Z=-4.043, P<0.001). There were no significant differences in gender, age, MCV, PLT count, or MPV among children with HSPN, those with HSPWN, and healthy children (P>0.05). Compared with healthy children, children with HSPN and HSPWN had significantly higher blood WBC count, RDW-CV, and RDW-SD (Z=46.760, P<0.001; Z=32.984, P<0.001; Z=28.343, P<0.001), but significantly lower blood RBC count, Hb, and Hct (t=4.375, P=0.014; Z=20.623, P<0.001; Z=18.256, P<0.001). Compared with children with HSPWN, RDW-SD in HSPN patients was significantly higher (P<0.05), but the other indicators were not statistically significant between the two groups (P>0.05). RDW-CV was positively correlated with blood WBC, RBC count, and RDW-SD in children with HSP (r=0.189, P=0.047; r=0.263, P=0.005; r=0.217, P=0.023), and negatively correlated with Hb, Hct, and MCV (r=-0.329, P<0.001; r=-0.194, P=0.042; r=-0.447, P<0.001). RDW-CV had no correlation with CRP, Fib, D-dimer, or cholesterol (r=0.029, 0.021, -0.143, and 0.015, respectively, P>0.05). RDW-SD had a positive correlation with MCV, RDW-CV, and cholesterol in children with HSP (r=0.434, P<0.001; r=0.217, P=0.023; r=0.360, P<0.001), but had a negative correlation with RBC count and D-dimer (r=-0.213, P=0.026; r=-0.301, P=0.003). RDW-SD had no correlation with WBC count, Hb, Hct, CRP, or Fib (r=-0.027, 0.060, 0.139, -0.073, and -0.195, respectively, P>0.05).

Conclusion

RDW is elevated in children with HSP, but it remains to be further studied whether RDW can predict the progression of HSP to HSPN in children.

Key words: Children, Henoch-Sch?nlein purpura, Henoch-Sch?nlein purpura nephritis, Red blood cell distribution width

Xinye Li, Yuanfeng Lu, Huihe Tang, Fenglang Shi, Kaiyuan Zheng, Yimei Yang, Yan Dai. Clinical value of red blood cell distribution width in children with Henoch-Schönlein purpura[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(01): 7-12.

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References 21

1	Pohl M.Henoch-Schönlein purpura nephritis [J]. Pediatr Nephrol, 2015, 30(2): 245-252.
2	Zhu X, Zhang M, Lan F, et al. The relationship between red cell distribution width and the risk of Henoch-Schönlein purpura nephritis [J]. Br J Biomed Sci, 2018, 75(1): 30-35.
3	Xu H, Li W, Mao JH, et al. Association between red blood cell distribution width and Henoch-Schonlein purpura nephritis [J]. Medicine (Baltimore), 2017, 96(23): e7091.
4	中华医学会儿科学分会免疫学组. 儿童过敏性紫癜循证诊治建议[J]. 中华儿科杂志, 2013, 51 (7): 502-507.
5	中华医学会儿科学分会肾脏病学组.儿童常见肾脏疾病诊治循证指南(二):紫癜性肾炎的诊治循证指南(试行) [J]. 中华儿科杂志, 2009, 47(12): 911-913.
6	Davin JC. Henoch-Schonlein purpura nephritis: pathophysiology, treatment, and future strategy [J]. Clin J Am Soc Nephrol, 2011, 6(3): 679-689.
7	Kawasaki Y, Ono A, Ohara S, et al. Henoch-Schönlein purpura nephritis in childhood: pathogenesis, prognostic factors and treatment [J]. Fukushima J Med Sci, 2013, 59(1):15-26.
8	Pillebout E, Jamin A, Ayari H, et al. Biomarkers of IgA vasculitis nephritis in children [J]. PLoS One, 2017, 12(11): e0188718.
9	López-Mejías R, Castañeda S, Genre F, et al. Genetics of immunoglobulin-A vasculitis (Henoch-Schönlein purpura): an updated review [J]. Autoimmun Rev，2018, 17(3):301-315.
10	Xu H, Pan Y, Li W, et al. Association between IL17A and IL17F polymorphisms and risk of Henoch-Schonlein purpura in Chinese children [J]. Rheumatol Int, 2016, 36(6): 829-835.
11	Chao TK, Rifai A, Ka SM, et al. The endogenous immune response modulates the course of IgA-immune complex mediated nephropathy [J]. Kidney Int, 2006, 70(2): 283-297.
12	Zhang Z, Zhao S, Zhang L, et al. A higher frequency of CD4(＋)CXCR5(＋) T follicular helper cells in patients with newly diagnosed Henoch-Schönlein purpura nephritis [J]. Int Immunopharmacol, 2016, 32: 8-15.
13	Miyamoto K, Inai K, Takeuchi D, et al. Relationships among red cell distribution width, anemia, and interleukin-6 in adult congenital heart disease [J]. Circ J, 2015, 79(5): 1100-1106.
14	Nada AM.Red cell distribution width in type 2 diabetic patients [J]. Diabetes Metab Syndr Obes, 2015, 8: 525-533.
15	Ay S, Eryilmaz MA, Aksoy N, et al.Is early detection of colon cancer possible with red blood cell distribution width? [J]. Asian Pac J Cancer Prev, 2015, 16(2): 753-756.
16	Song CS, Park DI, Yoon MY, et al. Association between red cell distribution width and disease activity in patients with inflammatory bowel disease [J]. Dig Dis Sci, 2012, 57(4): 1033-1038.
17	Rodríguez-Carrio J, Alperi-López M, López P, et al. Red cell distribution width is associated with cardiovascular risk and disease parameters in rheumatoid arthritis [J]. Rheumatology (Oxford), 2015, 54(4): 641-646.
18	Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock [J]. Am J Emerg Med, 2013, 31(3): 545-548.
19	Solak Y, Yilmaz MI, Saglam M, et al. Red cell distribution width is independently related to endothelial dysfunction in patients with chronic kidney disease [J]. Am J Med Sci, 2014, 347(2): 118-124.
20	Hong J, Yang HR.Laboratory markers indicating gastrointestinal involvement of henoch-schönlein purpura in children [J]. Pediatr Gastroenterol Hepatol Nutr, 2015, 18(1): 39-47.
21	王芳，张迎辉. 胱抑素C、纤维蛋白原及24 h尿蛋白定量与紫癜性肾炎患儿肾脏病理分级的相关性研究[J]. 中国当代儿科杂志, 2016, 18(3): 233-237.

项目	?	HSP患儿	健康儿童	统计值	P值
性别	男（例）	74	33	χ²=0.229	0.632
性别	女（例）	38	20	χ²=0.229	0.632
年龄［岁，M（P₂₅，P₇₅）］		7.0（5.0，9.0）	6.0（4.5，8.5）	Z=-0.856	0.392
WBC［10⁹/L，M（P₂₅，P₇₅）］		12.01（8.57，14.71）	6.94（6.12，8.25）	Z=-6.838	＜0.001
RBC（10¹²/L，±s）		4.68±0.61	4.93±0.49	t=-2.701	0.008
Hb［g/L，M（P₂₅，P₇₅）］		124.0（116.0，131.0）	132.0（126.5，138.0）	Z=-4.396	＜0.001
Hct［M（P₂₅，P₇₅）］		0.379（0.354，0.390）	0.394（0.376，0.413）	Z=-4.043	＜0.001
MCV［fl，M（P₂₅，P₇₅）］		81.4（78.2，84.2）	80.2（78.4，82.3）	Z=-0.607	0.544
RDW-CV［%，M（P₂₅，P₇₅）］		13.60（12.90，14.50）	12.70（12.35，13.00）	Z=-5.437	＜0.001
RDW-SD［fl，M（P₂₅，P₇₅）］		39.00（36.90，41.40）	36.40（35.45，37.85）	Z=-4.681	＜0.001
PLT（10⁹/L，±s）		367.01±121.69	342.09±65.78	t=1.709	0.089
MPV［fl，M（P₂₅，P₇₅）］		9.20（8.70，10.10）	9.10（8.65，9.70）	Z=-0.459	0.646

项目	?	HSP患儿	健康儿童	统计值	P值
性别	男（例）	74	33	χ²=0.229	0.632
性别	女（例）	38	20	χ²=0.229	0.632
年龄［岁，M（P₂₅，P₇₅）］		7.0（5.0，9.0）	6.0（4.5，8.5）	Z=-0.856	0.392
WBC［10⁹/L，M（P₂₅，P₇₅）］		12.01（8.57，14.71）	6.94（6.12，8.25）	Z=-6.838	＜0.001
RBC（10¹²/L，±s）		4.68±0.61	4.93±0.49	t=-2.701	0.008
Hb［g/L，M（P₂₅，P₇₅）］		124.0（116.0，131.0）	132.0（126.5，138.0）	Z=-4.396	＜0.001
Hct［M（P₂₅，P₇₅）］		0.379（0.354，0.390）	0.394（0.376，0.413）	Z=-4.043	＜0.001
MCV［fl，M（P₂₅，P₇₅）］		81.4（78.2，84.2）	80.2（78.4，82.3）	Z=-0.607	0.544
RDW-CV［%，M（P₂₅，P₇₅）］		13.60（12.90，14.50）	12.70（12.35，13.00）	Z=-5.437	＜0.001
RDW-SD［fl，M（P₂₅，P₇₅）］		39.00（36.90，41.40）	36.40（35.45，37.85）	Z=-4.681	＜0.001
PLT（10⁹/L，±s）		367.01±121.69	342.09±65.78	t=1.709	0.089
MPV［fl，M（P₂₅，P₇₅）］		9.20（8.70，10.10）	9.10（8.65，9.70）	Z=-0.459	0.646

项目	?	HSPN患儿	HSPWN患儿	健康儿童	统计值	P值
性别	男（例）	28	46	33	χ²=0.417	0.812
性别	女（例）	16	22	20	χ²=0.417	0.812
年龄［岁，M（P₂₅，P₇₅）］		8.00（5.00，10.00）	6.00（4.75，9.00）	6.00（4.50，8.50）	Z=4.975	0.083
WBC［（10⁹/L，M（P₂₅，P₇₅）］		11.44（8.69，15.39）	12.38（8.47，14.20）	6.94（6.12，8.25）^ab	Z=46.760	＜0.001
RBC（10¹²/L，±s）		4.60±0.78	4.73±0.47	4.93±0.49^ab	t=4.375	0.014
Hb［g/L，M（P₂₅，P₇₅）］		124.0（113.0，137.5）	123.5（117.0，130.0）	132.0（126.5，138.0）^ab	Z=20.623	＜0.001
Hct［M（P₂₅，P₇₅）］		0.383（0.346，0.411）	0.376（0.355，0.388）	0.394（0.376，0.413）^ab	Z=18.256	＜0.001
MCV［fl，M（P₂₅，P₇₅）］		82.20（78.05，86.75）	81.05（77.98，83.83）	80.20（78.40，82.00）	Z=2.351	0.309
RDW-CV［%，M（P₂₅，P₇₅）］		14.10（13.25，15.00）	13.30（12.90，14.08）	12.70（12.35，13.00）^ab	Z=32.984	＜0.001
RDW-SD［fl，M（P₂₅，P₇₅）］		40.20（38.50，42.85）	38.30（36.75，40.03）^a	36.00（35.45，37.85）^ab	Z=28.343	＜0.001
PLT（10⁹/L，±s）		371.18±115.76	364.26±126.23	342.09±65.78	t=1.026	0.361
MPV［fl，M（P₂₅，P₇₅）］		9.40（8.90，9.90）	9.20（8.68，9.70）	9.00（8.65，9.00）	Z=1.662	0.436

项目	?	HSPN患儿	HSPWN患儿	健康儿童	统计值	P值
性别	男（例）	28	46	33	χ²=0.417	0.812
性别	女（例）	16	22	20	χ²=0.417	0.812
年龄［岁，M（P₂₅，P₇₅）］		8.00（5.00，10.00）	6.00（4.75，9.00）	6.00（4.50，8.50）	Z=4.975	0.083
WBC［（10⁹/L，M（P₂₅，P₇₅）］		11.44（8.69，15.39）	12.38（8.47，14.20）	6.94（6.12，8.25）^ab	Z=46.760	＜0.001
RBC（10¹²/L，±s）		4.60±0.78	4.73±0.47	4.93±0.49^ab	t=4.375	0.014
Hb［g/L，M（P₂₅，P₇₅）］		124.0（113.0，137.5）	123.5（117.0，130.0）	132.0（126.5，138.0）^ab	Z=20.623	＜0.001
Hct［M（P₂₅，P₇₅）］		0.383（0.346，0.411）	0.376（0.355，0.388）	0.394（0.376，0.413）^ab	Z=18.256	＜0.001
MCV［fl，M（P₂₅，P₇₅）］		82.20（78.05，86.75）	81.05（77.98，83.83）	80.20（78.40，82.00）	Z=2.351	0.309
RDW-CV［%，M（P₂₅，P₇₅）］		14.10（13.25，15.00）	13.30（12.90，14.08）	12.70（12.35，13.00）^ab	Z=32.984	＜0.001
RDW-SD［fl，M（P₂₅，P₇₅）］		40.20（38.50，42.85）	38.30（36.75，40.03）^a	36.00（35.45，37.85）^ab	Z=28.343	＜0.001
PLT（10⁹/L，±s）		371.18±115.76	364.26±126.23	342.09±65.78	t=1.026	0.361
MPV［fl，M（P₂₅，P₇₅）］		9.40（8.90，9.90）	9.20（8.68，9.70）	9.00（8.65，9.00）	Z=1.662	0.436

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