摘要目的:探究趋化因子12(CXCL12)、视黄酸受体反应蛋白2(Chemerin)在儿童特发性膜性肾病(IMN)诊治及预后中的意义。方法:选取本院2018年10月至2020年9月收治的108例IMN患儿作为研究组，同时选取同期90例健康体检儿童作为对照组。观察两组入选者及不同分期IMN患者的血清CXCL12和Chemerin表达水平，观察研究组患者的免疫组化染色阳性率。针对研究组中肾组织CXCL12、Chemerin阳性及阴性患者，检测并比较其血清血肌酐(CREA)、血白蛋白(ALB)、血尿氮素(BUN)和尿液膜攻复合物(C5b-9)、足细胞标志蛋白(PCX)指标，并根据随访结果分析治疗6个月后患者的病情缓解和预后情况。结果:研究组的血清CXCL12和Chemerin表达水平均高于对照组(均 P<0.05)。四种病理分期患者之间的血清CXCL12和Chemerin表达水平比较，差异均有统计学意义(均 P<0.05)，其中Ⅳ期患者的CXCL12和Chemerin表达水平最高，Ⅲ期、Ⅱ期患者次之，Ⅰ期患者表达水平最低。研究组中肾组织CXCL12阳性患儿75例(69.44%)，阴性33例(30.56%)；Chemerin阳性患儿84例(77.78%)，阴性24例(22.23%)。肾组织CXCL12阳性和Chemerin阳性患儿的血液CREA、BUN和尿液C5b-9、PCX含量均高于相应阴性患儿(均 P<0.05)，CXCL12阳性和Chemerin阳性患儿的ALB含量均低于阴性患儿(均 P<0.05)。CXCL12阳性患儿6个月后的缓解率低于CXCL12阴性患儿(61.33% vs. 100%， P<0.05)；同样，Chemerin阳性患儿6个月后的缓解率低于Chemerin阴性患儿(64.29% vs. 95.83%， P<0.05)。随访12个月后，CXCL12阳性患儿的终点事件发生率高于CXCL12阴性患儿(34.67% vs. 3.03%， P<0.05)；Chemerin阳性患儿的终点事件发生率高于Chemerin阴性患儿(25.00% vs. 0， P<0.05)。 结论:CXCL12、Chemerin的表达水平能够为儿童IMN的诊断提供指导，同时还能预测患儿的预后，其表达水平越高，预后越差。

abstractsObjective:To investigate the value of CXC-Chemokine ligand 12 (CXCL12) and Chemerin in the diagnosis, treatment and prognosis evaluation in children with idiopathic membranous nephropathy (IMN).Methods:A total of 108 children with IMN admitted to our hospital from October 2018 to September 2020 were selected as the study group, and 90 healthy children in the same period were selected as the control group. Expression levels of serum CXCL12 and Chemerin were compared between two groups. The positive rate of CXCL12 and Chemerin was observed under immunohistochemical staining, then serum levels of creatinine (CREA), albumin (ALB), blood urea nitrogen (BUN), complement proteins C5b-9, and podocalyxin (PCX) were compared between patients with positive and negative expressions. The remission rate and prognosis status were recorded during the six-month follow-up period.Results:The expression levels of serum CXCL12 and Chemerin in study group were higher than those in control group (all P<0.05). Serum CXCL12 and Chemerin expression levels demonstrated statistical difference among patients with different pathological stages, which were the highest in stage Ⅳ, followed by stage Ⅲ and Ⅱ, and were the lowest in stage Ⅰ (all P<0.05). In the study group, 75 cases (69.44%) were positive for CXCL12 and 33 cases (30.56%) were negative, meantime, Chemerin was positive in 84 cases (77.78%) and negative in 24 cases (22.23%). Blood CREA, BUN and urine C5b-9 and PCX levels were higher in CXCL12-positive and Chemerin-positive children than in the corresponding negative children (all P<0.05). ALB levels were lower in CXCL12-positive and Chemerin-positive children than in negative children (all P<0.05). After 6 months, the remission rate in CXCL12-positive children was 61.33%, which was lower than 100% of CXCL12-negative children ( P<0.05). The remission rate in Chemerin-positive children was 64.29% at 6 months, which was lower than 95.83% in Chemerin-negative children ( P<0.05). During the 12-month follow-up period, the incidence of end point events in CXCL12-positive patients was significantly higher than that in negative patients (35.67% vs. 3.03%, P<0.05). The incidence of endpoint events in chemerin positive patients was significantly higher than that in negative patients (25.00% vs. 0, P<0.05). Conclusions:The expression levels of CXCL12 and Chemerin can provide guidance for the diagnosis of children with idiopathic membranous nephropathy, and also predict the prognosis of children, moreover, children with higher expression may suffer a worse prognosis.