本文關(guān)鍵詞： 兒童 紫癜性腎炎 高危因素　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:過敏性紫癜(Henoch-Schonlein purpura HSP)是一種由免疫復(fù)合物介導(dǎo)的全身多系統(tǒng)性的小血管炎,發(fā)病人群主要為兒童,以皮膚、消化道、關(guān)節(jié)、腎臟受累為主,當(dāng)腎臟出現(xiàn)累及時則為紫癜性腎炎(Henoch-Schonlein purpura nephritis HSPN),紫癜性腎炎也是兒童常見繼發(fā)性腎小球腎炎。絕大多數(shù)的HSPN患兒的臨床表現(xiàn)為一過性鏡下血尿和(或)少量蛋白尿,通過及時、正確的治療后,都能達(dá)到滿意的治療效果,但仍有1%~17%的HSPN的患兒預(yù)后很差,最終導(dǎo)致腎臟衰竭。因而分析影響腎臟損害的相關(guān)危險因素,對提高紫癜性腎炎的預(yù)后具有重要意義。方法:本研究回顧性分析于某某醫(yī)科大學(xué)附屬第二醫(yī)院從2015年1月~2016年7月收治住院的過敏性紫癜患兒。共86例,其中男孩34例,女孩52例,平均年齡7.89±2.56歲。診斷標(biāo)準(zhǔn)按照《諸福棠實用兒科學(xué)》中提出的相關(guān)標(biāo)準(zhǔn)�；純杭韧w健,均為首次發(fā)病,除外已經(jīng)確診的其他類型的腎臟疾病,血小板減少性紫癜及其他類型的系統(tǒng)性血管炎。根據(jù)86例過敏性紫癜患兒中根據(jù)有無腎臟損害可分成下列兩組:50例為非HSPN組和36例為HSPN組。依次比較分析不同組別病人的年齡、性別、重復(fù)皮疹超過3次、是否伴有關(guān)節(jié)痛或腹痛、鏈球菌滴度水平、外周靜脈血PLT計數(shù)、外周靜脈血IgA、IgG、IgM,CD4/CD81,補體(C3、C4)水平、C-反應(yīng)蛋白、紅細(xì)胞沉降率、纖維蛋白原,尿液相關(guān)檢測(尿常規(guī)、尿微量白蛋白、24小時尿蛋白定量、愛迪氏計數(shù))等實驗室指標(biāo)作為研究因素,利用SPSS19.00進(jìn)行統(tǒng)計分析。結(jié)果:1、腎損傷發(fā)生特點:86例過敏性紫癜患兒,有36例發(fā)生了不同程度的腎損害,發(fā)生率為41.9%。其中2例符合腎穿標(biāo)準(zhǔn),行腎臟穿刺檢查。2、86例均表現(xiàn)為不同程度的皮疹(100%),伴關(guān)節(jié)癥狀的34例(39.5%),腹型9例(10.5%)3、通過分析腎損害組與非腎損害組的一般情況及臨床特點顯示:年齡≥7歲、反復(fù)皮疹≥3次,在腎臟損傷組和非腎臟損傷組間有統(tǒng)計學(xué)意義(P0.05),而性別、關(guān)節(jié)痛、腹痛、關(guān)節(jié)痛合并腹痛等在兩組間無顯著差異(P0.05)。4、分析過敏性紫癜患兒的生化及免疫指標(biāo)結(jié)果顯示:鏈球菌感染、IgG增高、補體C3下降、FIB、PLT增高在有無腎臟損傷兩組之間存在差異(P0.05),而CRP、ESR、IgA、IgM、CD4/CD81、補體C4在兩組間無顯著差異(P0.05)。進(jìn)一步對腎損害的危險因素因素進(jìn)行Logistic回歸分析結(jié)果表明年齡≥7歲、反復(fù)皮疹≥3次、鏈球菌感染、FIB、PLT增高、補體C3下降是紫癜性腎炎發(fā)生的獨立危險因素。結(jié)論:1、兒童過敏性紫癜損害的發(fā)生率為41.9%;2、IgG升高可能是紫癜性腎炎發(fā)生的高危因素之一;3、年長兒、反復(fù)皮疹≥3次、鏈球菌感染、FIB、PLT增高、補體C3下降可能是發(fā)生腎損害的危險因素。
[Abstract]:Objective: Henoch-Schonlein purpura is a systemic and systemic vasculitis mediated by immune complex. When kidney involvement occurs, Henoch-Schonlein purpura nephritis HSPNNU, purpura nephritis is also a common secondary glomerulonephritis in children. The majority of children with HSPN have transient hematuria and / or a small amount of proteinuria. After correct treatment, satisfactory results can be achieved, but there are still 11% of the children with HSPN who have poor prognosis and eventually lead to renal failure. Methods: from January 2015 to July 2016, 86 patients with Henoch-Schonlein purpura were treated in the second affiliated Hospital of some Medical University. There were 86 cases of Henoch-Schonlein purpura, 34 of which were boys. 52 cases of girls (mean age 7.89 鹵2.56 years) were diagnosed according to the relevant criteria in practical Pediatrics of Zhu Futang. Thrombocytopenic purpura and other types of systemic vasculitis. According to 86 children with Henoch-Schonlein purpura according to the presence or absence of renal damage can be divided into the following two groups: 50 cases are non-#en0# group and 36 cases are HSPN group. Sex, repeated rash more than 3 times, whether accompanied by arthralgia or abdominal pain, streptococcus titer level, peripheral venous blood PLT count, peripheral venous blood IgA IgGN IgMU CD4 / CD81, complement C3C4) levels of C-reactive protein, erythrocyte sedimentation rate, fibrinogen, Urine correlation test (urine routine, urinary microalbuminuria 24 hours urine protein quantitative, Eddie's count) and other laboratory indexes were used as the research factors, and were statistically analyzed by SPSS19.00. Results: the characteristics of renal injury in 86 children with Henoch-Schonlein purpura were as follows: 1. There were 36 cases with different degrees of renal damage, with an incidence of 41.9%. Renal puncture examination was performed in 86 cases with different degrees of rashes, 34 cases with joint symptoms (39.5%) and 9 cases with abdominal type (10.5%). The general situation and clinical characteristics of renal injury group and non-renal lesion group were analyzed. The results showed that age 鈮，

本文編號：1520641