Analysis of the relationship between serum CTLA4,S100A12 levels and disease condition and prognosis in children with primary nephrotic syndrome

Wu Chen; Dong Chen; Zhuang Yafei; Zang Yaoyao; Liang Juan; Guan Fengjun

doi:10.3969/j.issn.1671-6450.2025.02.015

Abstract：Objective To investigate the relationship between serum levels of cytotoxic T-lymphocyte antigen-4(CTLA4)and S100 calcium-binding protein A12(S100A12)and the condition and prognosis of children with primary ne-phrotic syndrome(PNS).Methods A total of 129 children with PNS admitted to the Department of Pediatrics,Affiliated Hospital of Xuzhou Medical University from June 2019 to June 2021 were retrospectively selected as the PNS group.Ac-cording to different conditions,the children were divided into simple PNS subgroup(69 cases)and nephritis PNS subgroup(60 cases);According to the prognosis of 3 years after treatment,the children were divided into poor prognosis subgroup(23 cases)and good prognosis subgroup(104 cases).108 healthy children were selected as healthy control group.The levels of serum CTLA4 and S100A12 were detected by enzyme-linked immunosorbent assay.Pearson method was used to analyze the correlation between serum CTLA4,S100A12 levels and serum Alb levels,renal function indexes in children with PNS.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in children with PNS.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CTLA4 and S100A12 levels for poor prognosis in children with PNS.Results The serum CTLA4 level in the PNS group was lower than that in the healthy control group,and the serum S100A12 level was higher than that in the healthy control group(t/P=22.138/＜0.001,17 374/＜0.001);The levels of serum S100A12,BUN,SCr and 24 h urine protein in the nephritis PNS subgroup were higher than those in the simple PNS subgroup,and the levels of serum CTLA4 and Alb were lower than those in the simple PNS subgroup(t/P=11.092/＜0.001,7.832/＜0.001,7.379/＜0.001,8.090/＜0.001,14.359/＜0.001,7.455/＜0.001);Pearson correlation analysis showed that serum CTLA4 level in children with PNS was positively correlated with Alb level,and nega-tively correlated with BUN,SCr and 24 h urine protein level(r/P=0.464/0.001,-0365/0.012,-0328/0.019,-0507/＜0.001).Serum S100A12 level was positively correlated with BUN,SCr and 24 h urine protein level,and negatively correlated with Alb level(r/P=0286/0.031,0.307/0.023,0.427/0.003,-0.338/0.009).The proportion of nephritis PNS,BUN,SCr,24 h urine protein and S100A12 levels in the poor prognosis subgroup were higher than those in the good prognosis subgroup,and the levels of serum Alb and CTLA4 were lower than those in the good prognosis subgroup(x2/t/P=10.841/0.001,6 397/＜0.001,2.644/0.009,11.690/＜0.001,6.834/＜0.001,5.558/＜0.001,3.874/＜0.001);Nephritic PNS and high S100A12 were in-dependent risk factors for poor prognosis in children with PNS[OR(95％CI)=2.236(1.211-4.131),1.887(1.114-3.197)],and high CTLA4 was an independent protective factor[OR(95％CI)=0.439(0221-0.877)];The AUC of se-rum CTLA4,S100A12 levels and the combination of the two in predicting the poor prognosis of children with PNS were 0.754,0.731 and 0.959,respectively.The AUC of the combination of the two was greater than that of the single prediction(Z/P=3.866/＜0.001,3.033/＜0.001).Conclusion The decrease of serum CTLA4 level and the increase of S100A12 level in children with PNS are related to the aggravation of PNS and poor prognosis,which can be used as a marker for the progno-sis of PNS.