本文選題：過敏性紫癜　切入點：紫癜性腎炎　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：1.目的：研究各組患兒體內(nèi)血尿中性粒細(xì)胞明膠酶相關(guān)載脂蛋（Urinaryand Serum Neutrophil Gelatinase-Associated Lipocalin, uNGAL andsNGAL）和尿視黃醇結(jié)合蛋白（Urinary Retinol Binding Protein, uRBP）、三項指標(biāo)的水平及其之間的相關(guān)性，以及其預(yù)示小兒過敏性紫癜腎損傷的敏感性是否高于尿微量白蛋白、尿β2微球蛋白。方法：選初次罹患HSP患兒60例為實驗組，30例同期在本院門診體檢的正常健康兒童作為正常對照組,其年齡、性別與實驗組相匹配。實驗組所有患兒于入院當(dāng)日輸液前均抽取2ml靜脈血離心后取上清液，置-80℃冰箱凍存待測sNGAL。入院次日清晨取患兒晨尿10ml，置無內(nèi)毒素及致熱原的試管中，離心后分裝EP管內(nèi)并置-80℃冰箱凍存待測uNGAL、uRBP、尿微量白蛋白（urinemicroalbumin，uMA）、尿β2微球蛋白（urine β2microglobulin，uβ2-MG）。其后根據(jù)uMA、uβ2-MG結(jié)果將所有實驗組HSP患兒再分為Ⅰ.過敏性紫癜無腎損害組（non-HSPN組）26例，Ⅱ.過敏性紫癜腎損害組（即紫癜性腎炎組,HSPN組）34例。所有正常對照組兒童均在門診空腹當(dāng)日抽取2ml靜脈血及取晨尿10ml，處理方法同實驗組。本研究還對實驗組患兒臨床治愈出院后半個月進(jìn)行隨訪，設(shè)為過敏性紫癜無腎損害隨訪組（non-HSPN隨訪組）及HSPN隨訪組。所有隨訪患兒均檢測sNGAL、uNGAL、uRBP、uMA、uβ2-MG；并與正常對照組、non-HSPN組、HSPN組進(jìn)行比較。結(jié)果：1. non-HSPN組的uNGAL、sNGAL、uRBP、uMA、uβ2-MG等各項指標(biāo)的均數(shù)±標(biāo)準(zhǔn)差分別為（0.1370±0.0256）mg/L、（0.1566±0.0386）mg/L、（0.786±0.123）mg/L、（10.44±2.33）mg/L、（0.171±0.047）mg/L；HSPN組中上述各指標(biāo)的均數(shù)±標(biāo)準(zhǔn)差分別為（0.1370±0.0256）mg/L、（0.1566±0.0386）mg/L、（1.430±0.342）mg/L、（37.19±9.84）mg/L、（0.704±0.204）mg/L；正常組的上述各項指標(biāo)均數(shù)±標(biāo)準(zhǔn)差分別為（0.0108±0.0029）mg/L、（0.0499±0.0206）mg/L、（0.166±0.054）mg/L、（9.39±1.17）mg/L、（0.157±0.019）mg/L。HSPN組的各項指標(biāo)均較non-HSPN組明顯增高，差異有統(tǒng)計學(xué)意義（P值均0.001）。non-HSPN組中uNGAL、sNGAL、uRBP較正常組增高，差異有統(tǒng)計學(xué)意義（P0.01）；HSPN隨訪組中的uNGAL、sNGAL、uRBP仍持續(xù)較高的水平，較正常組明顯增高，有統(tǒng)計學(xué)意義（P0.01）。non-HSPN隨訪組中的uNGAL、sNGAL、uRBP較正常對照組增高，，差異有統(tǒng)計學(xué)意義（P0.01）。2.根據(jù)相關(guān)性研究發(fā)現(xiàn)此六項檢測指標(biāo)之間都具有相關(guān)性，各組內(nèi)sNGAL與uNGAL、uRBP、uMA、uβ2-MG呈正相關(guān)，有統(tǒng)計學(xué)意義（P0.01）；uNGAL與sNGAL、uRBP、uMA、uβ2-MG呈正相關(guān)（P0.01）；uRBP與uNGAL、sNGAL、uMA、uβ2-MG呈正相關(guān)關(guān)系（P0.01）。研究推測血uNGAL、uRBP、sNGAL的水平在各組中隨著uMA、uβ2-MG的增高而增高。結(jié)論：1.過敏性紫癜中不管是否存在腎損害，sNGAL、uNGAL、uRBP的水平明顯高于正常對照組，且其水平隨著患兒腎損害程度加重而逐漸增高。2.兩隨訪組中sNGAL、uNGAL、 uRBP水平明顯高于正常組，因此它們可用于過敏性紫癜患兒隨訪腎功能的檢測指標(biāo)。3.uNGAL、sNGAL、uRBP對過敏性紫癜早期腎損害的預(yù)測敏感性優(yōu)于uMA、uβ2-MG，且出現(xiàn)的時間較uMA、uβ2-MG早。4.上述各項檢測指標(biāo)的聯(lián)合應(yīng)用能夠提高判斷過敏性紫癜患兒早期腎損害的準(zhǔn)確率。
[Abstract]:1. Objective: To study the serum in vivo urine neutrophil gelatinase associated lipocalin (Urinaryand Serum Neutrophil Gelatinase-Associated Lipocalin egg, uNGAL andsNGAL) and urinary retinol binding protein (Urinary Retinol Binding Protein, uRBP), three indicators of the level and the correlation between the sensitivity and the allergic purpura kidney damage in children is higher than that of the urine albumin, urine beta 2 microglobulin. Methods: the first incidence of 60 HSP patients as the experimental group, 30 cases of healthy children in outpatient medical examination in our hospital as the control group, the age, gender matched with the experimental group. The experimental group of all patients on admission were collected 2ml venous blood transfusion before centrifugation the supernatant after -80 deg.c, refrigerator freezing test sNGAL. the next morning of admission from children urinary 10ml, the endotoxin and pyrogen test tube, after centrifugation URBP packaging EP tube collocated -80 C refrigerator uNGAL cryopreservation, measured urinary albumin (urinemicroalbumin, uMA), urine beta 2 microglobulin (urine beta 2microglobulin, u beta 2-MG). According to uMA, u beta 2-MG all of the experimental group HSP were divided into 1. Allergic purpura without renal damage group (non-HSPN group) 26 cases of allergic purpura kidney damage group (i.e. purpura nephritis group, HSPN group) 34 cases of normal control group. All children were in outpatient day fasting venous blood and collected 2ml urine samples of 10ml treated in the same way as the experimental group. The patients in the experimental group were cured from the second half of the month were followed up for allergic purpura without renal damage in follow-up group (non-HSPN group and HSPN group were followed up). All patients were followed up for detection of sNGAL, uNGAL, uRBP, uMA, u and beta 2-MG; and the normal control group, non-HSPN group and HSPN group were compared. Results: 1. non-HSPN group uNGAL, sNGAL, uRB P,uMA,u尾2-MG絳夊悇欏規(guī)寚鏍囩殑鍧囨暟鹵鏍囧噯宸垎鍒負(fù)(0.1370鹵0.0256)mg/L,(0.1566鹵0.0386)mg/L,(0.786鹵0.123)mg/L,(10.44鹵2.33)mg/L,(0.171鹵0.047)mg/L錛汬SPN緇勪腑涓婅堪鍚勬寚鏍囩殑鍧囨暟鹵鏍囧噯宸垎鍒負(fù)(0.1370鹵0.0256)mg/L,(0.1566鹵0.0386)mg/L,(1.430鹵0.342)mg/L,(37.19鹵9.84)mg/L,(0.704鹵0.204)mg/L錛涙甯哥粍鐨勪笂榪板悇欏規(guī)寚鏍囧潎鏁奧辨爣鍑嗗樊鍒嗗埆涓

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