Objective  To explore the relationship between serum levels of nuclear factor κB (NF-κB), CXC motif chemokine ligand 13 (CXCL13), and a disintegrin and metalloprotinase-17 (ADAM17) in children with primary immune thrombocytopenia (ITP) and their prognosis.

Methods  Children with ITP and those who were physically healthy, admitted to Wuhan First Hospital from September 2022 to September 2024, were selected as the subjects. They were divided into ITP group and control group. Based on the prognosis of the children after 4 weeks of treatment, the ITP group was further divided into the treatment-effective group and the treatment-ineffective group. The levels of serum NF-κB, CXCL13, and ADAM17 were measured using the ELISA method. Multivariate Logistic analysis was used to identify the factors affecting the treatment ineffectiveness in ITP patients. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive value of NF-κB, CXCL13, and ADAM17 levels in predicting treatment ineffectiveness in ITP patients.

Results  A total of 276 subjects were included in the study, with 138 in the ITP group and 138 in the control group, 93 in the treatment-effective group and 45 in the treatment-ineffective group. The serum levels of NF-κB, CXCL13, and ADAM17 in children in the ITP group were significantly higher than those in the control group (P<0.05). Elevated levels of NF-κB, CXCL13, ADAM17, and Th17/Treg were risk factors for ineffective treatment in ITP patients (P<0.05). ROC curve analysis showed that the AUCs for predicting ineffective treatment in ITP patients using the levels of NF-κB, CXCL13, and ADAM17 were 0.833, 0.816, and 0.837, respectively. The AUC for predicting ineffective treatment using any one of these three markers was significantly lower than the AUC for predicting ineffective treatment using all three markers together (0.937).

Conclusion  The expression of serum NF-κB, CXCL13 and ADAM17 was upregulated in ITP children, which were the risk factors for ineffective treatment. The combined prediction value of these three factors was better than that of ITP children with ineffective treatment.

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