儿童紫癜性肾炎的高危因素分析

发布时间：2018-02-21 01:44

  本文关键词： 儿童 紫癜性肾炎 高危因素　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:过敏性紫癜(Henoch-Schonlein purpura HSP)是一种由免疫复合物介导的全身多系统性的小血管炎,发病人群主要为儿童,以皮肤、消化道、关节、肾脏受累为主,当肾脏出现累及时则为紫癜性肾炎(Henoch-Schonlein purpura nephritis HSPN),紫癜性肾炎也是儿童常见继发性肾小球肾炎。绝大多数的HSPN患儿的临床表现为一过性镜下血尿和(或)少量蛋白尿,通过及时、正确的治疗后,都能达到满意的治疗效果,但仍有1%~17%的HSPN的患儿预后很差,最终导致肾脏衰竭。因而分析影响肾脏损害的相关危险因素,对提高紫癜性肾炎的预后具有重要意义。方法:本研究回顾性分析于某某医科大学附属第二医院从2015年1月~2016年7月收治住院的过敏性紫癜患儿。共86例,其中男孩34例,女孩52例,平均年龄7.89±2.56岁。诊断标准按照《诸福棠实用儿科学》中提出的相关标准。患儿既往体健,均为首次发病,除外已经确诊的其他类型的肾脏疾病,血小板减少性紫癜及其他类型的系统性血管炎。根据86例过敏性紫癜患儿中根据有无肾脏损害可分成下列两组:50例为非HSPN组和36例为HSPN组。依次比较分析不同组别病人的年龄、性别、重复皮疹超过3次、是否伴有关节痛或腹痛、链球菌滴度水平、外周静脉血PLT计数、外周静脉血IgA、IgG、IgM,CD4/CD81,补体(C3、C4)水平、C-反应蛋白、红细胞沉降率、纤维蛋白原,尿液相关检测(尿常规、尿微量白蛋白、24小时尿蛋白定量、爱迪氏计数)等实验室指标作为研究因素,利用SPSS19.00进行统计分析。结果:1、肾损伤发生特点:86例过敏性紫癜患儿,有36例发生了不同程度的肾损害,发生率为41.9%。其中2例符合肾穿标准,行肾脏穿刺检查。2、86例均表现为不同程度的皮疹(100%),伴关节症状的34例(39.5%),腹型9例(10.5%)3、通过分析肾损害组与非肾损害组的一般情况及临床特点显示:年龄≥7岁、反复皮疹≥3次,在肾脏损伤组和非肾脏损伤组间有统计学意义(P0.05),而性别、关节痛、腹痛、关节痛合并腹痛等在两组间无显著差异(P0.05)。4、分析过敏性紫癜患儿的生化及免疫指标结果显示:链球菌感染、IgG增高、补体C3下降、FIB、PLT增高在有无肾脏损伤两组之间存在差异(P0.05),而CRP、ESR、IgA、IgM、CD4/CD81、补体C4在两组间无显著差异(P0.05)。进一步对肾损害的危险因素因素进行Logistic回归分析结果表明年龄≥7岁、反复皮疹≥3次、链球菌感染、FIB、PLT增高、补体C3下降是紫癜性肾炎发生的独立危险因素。结论:1、儿童过敏性紫癜损害的发生率为41.9%;2、IgG升高可能是紫癜性肾炎发生的高危因素之一;3、年长儿、反复皮疹≥3次、链球菌感染、FIB、PLT增高、补体C3下降可能是发生肾损害的危险因素。
[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 卤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，

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