本文選題：過敏性紫癜 + 消化道出血　； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:研究兒童過敏性紫癜(Henoch-Schonlein Purpura,HSP)臨床癥狀與相關(guān)實驗室指標(biāo)的關(guān)系,探討HSP患兒相關(guān)實驗室指標(biāo)對HSP發(fā)生消化道出血的預(yù)測價值,以盡早識別可能發(fā)生不良并發(fā)癥的患兒,以便醫(yī)務(wù)人員盡早發(fā)現(xiàn),盡早干預(yù),從而降低HSP患兒發(fā)生消化道出血的風(fēng)險。方法:收集2014年5月至2016年5月期間在蘭州大學(xué)第一醫(yī)院就診,首次診斷并收入院治療的HSP患兒。以148例處于急性期,未經(jīng)過糖皮質(zhì)激素及免疫抑制劑治療,并排外其他感染的HSP患兒為HSP組。同時收集77例因腹痛入院,但經(jīng)檢查后無任何器質(zhì)性病變的患兒為對照組。兩組均在入院當(dāng)日采集血樣,進(jìn)行血常規(guī)、血沉(Erythrocyte sedimentation rate,ESR)、C反應(yīng)蛋白(C-reactive protein,CRP)等的檢測。收集并記錄患兒的性別、年齡、住院天數(shù)、臨床癥狀、體征及激素的使用情況,并從相關(guān)化驗檢查結(jié)果中提取白細(xì)胞計數(shù)(White blood cell count,WBC)、淋巴細(xì)胞絕對值、中性粒細(xì)胞絕對值、血紅蛋白(Hemoglobin,Hb)、血小板計數(shù)((Platelet count,PLT)、平均血小板體積(Mean platelet volume,MPV)、CRP及ESR的值,計算出中性粒細(xì)胞與淋巴細(xì)胞絕對值的比值(Neutrophils to lymphocytes ratio,NLR)。結(jié)果:(1)本研究HSP組共納入148例HSP患兒,其中男81例,女67例,男與女比例為1.2:1;年齡2~16歲,平均年齡7.7±2.8歲;住院天數(shù)2~27天,平均住院6.5(5~9)天;大多冬春季發(fā)病;急性期以皮膚紫癜作為首發(fā)癥狀的有143例,以腹痛首發(fā)的有3例,以關(guān)節(jié)腫痛首發(fā)的有2例;HSP患兒合并消化道出血者39例,占26.4%,其中因并發(fā)腸套疊,并施行外科手術(shù)的有1例;經(jīng)明確診斷后使用激素治療的患兒111例,占總?cè)藬?shù)的75%。(2)HSP組WBC、中性粒細(xì)胞絕對值、NLR、PLT與對照組相比明顯升高,淋巴細(xì)胞絕對值與對照組相比明顯降低,差異具有統(tǒng)計學(xué)意義。(3)HSP消化道出血組的WBC、中性粒細(xì)胞絕對值、NLR和CRP較非消化道出血組明顯升高,淋巴細(xì)胞絕對值較非消化道出血組明顯降低,差異具有統(tǒng)計學(xué)意義。(4)HSP患兒的臨床評分與實驗室指標(biāo)WBC(r=0.344,P0.001)、中性粒細(xì)胞絕對值(r=0.405,P0.001)、NLR(r=0.364,P0.001)、PLT(r=0.185,P=0.024)及CRP(r=0.258,P=0.002)呈顯著正相關(guān)。(5)經(jīng)Logistic逐步回歸分析,CRP及NLR是HSP消化道出血的獨立危險因素。(6)根據(jù)ROC曲線下面積結(jié)果,與NLR相比,CRP是HSP消化道出血的潛在的更有效的預(yù)測指標(biāo)。結(jié)論:CRP7.25mg/L及NLR3.43可作為預(yù)測兒童HSP消化道出血的簡易指標(biāo),尤其對腹型HSP并發(fā)消化道出血的早期篩查可能具有更好的價值。
[Abstract]:Objective: to study the relationship between the clinical symptoms of Henoch-Schonlein Purpura HSPs in children with Henoch-Schonlein Purpura and the related laboratory indexes, and to explore the predictive value of the laboratory parameters in children with HSP for gastrointestinal bleeding in HSP, so as to identify the children with possible adverse complications as soon as possible. In order to reduce the risk of gastrointestinal bleeding in children with HSP, medical staff can detect and intervene as soon as possible. Methods: from May 2014 to May 2016, children with HSP were first diagnosed and admitted to the first Hospital of Lanzhou University. 148 children with HSP in acute stage without glucocorticoid and immunosuppressant were treated with HSP. At the same time, 77 children with abdominal pain who were admitted to hospital without any organic diseases were collected as the control group. Blood samples were collected from the two groups on the day of admission, and erythrocyte sedimentation ratec reactive protein (CRP) were measured. To collect and record the sex, age, hospitalization days, clinical symptoms, signs and hormone use of the children, and to extract the white blood cell count (White blood cell count), the absolute value of lymphocytes, and the absolute value of neutrophils from the results of laboratory examination. Hemoglobin (HB), platelet count (PLT), mean platelet volume (platelet), ESR, and the ratio of neutrophils to lymphocytes neutrophils (NLR) were calculated. Results in the HSP group, there were 148 children with HSP, including 81 males and 67 females, the ratio of male to female was 1.2: 1; the age was 216 years old, the average age was 7.7 鹵2.8 years; the hospital stay was 227 days, the average hospital stay was 6.5 days, and most of the disease occurred in winter and spring. In acute stage, there were 143 cases with skin purpura as the first symptom, 3 cases with abdominal pain, 39 cases (26.4%) with gastrointestinal hemorrhage in 2 cases (26.4%) with acute pain and joint swelling and pain, among which 1 case was complicated with intussusception and underwent surgical operation. The absolute value of neutrophils in 75%.(2)HSP group was significantly higher than that in control group, and the absolute value of lymphocytes was significantly lower than that in control group. The difference was statistically significant. The absolute values of neutrophil and neutrophil in the group of gastrointestinal hemorrhage were significantly higher than those in the group of non-gastrointestinal hemorrhage, and the absolute value of lymphocyte was significantly lower than that in the group of non-gastrointestinal hemorrhage. The difference was statistically significant. The clinical scores and laboratory indexes WBCrnr 0.344U P0.001, the absolute value of neutrophil 0.405P0.001P 0.001NLRRN 0.364P 0.001P 0.001P 0. 185P0. 024) and CRP rrr 0.258P0. 002) were positively correlated by Logistic stepwise regression analysis. CRP and NLR were independent risk factors of HSP gastrointestinal hemorrhage. (6) according to the results of the statistical analysis, there was a significant positive correlation between the clinical scores and the laboratory indexes. 5) by Logistic stepwise regression analysis, CRP and NLR were the independent risk factors of HSP gastrointestinal hemorrhage. The area results under the ROC curve, Compared with NLR, CRP is a potentially more effective predictor of gastrointestinal hemorrhage in HSP. ConclusionTwo five HSP 7.25mg / L and NLR3.43 can be used as a simple index for predicting gastrointestinal hemorrhage in children with HSP, especially for early screening of abdominal HSP complicated with gastrointestinal hemorrhage.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.5

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