紫癜性肾炎患儿不同蛋白尿水平临床特点与临床炎性指标的相关性研究

发布时间：2018-03-06 00:18

本文选题：过敏性紫癜　切入点：紫癜性肾炎　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:紫癜性肾炎是过敏性紫癜最严重的临床并发症,它严重影响患儿的预后及生活质量,多项有关紫癜性肾炎临床特点和临床相关炎性指标的研究,都以疾病整体的角度去研究,这就为不同病理水平以及不同蛋白尿水平患儿的个体化治疗带来困惑。本研究则以不同蛋白尿水平进行分组,阐述紫癜性肾炎的临床特点,并对尿蛋白定量与临床相关炎性指标间的相关性进行分析。方法:采用系统回顾的分析方法,收集自2014年10月至2016年10月在河北医科大学第二医院儿科肾脏及风湿免疫专业住院且符合中华医学会儿科学分会肾脏病学组于2009年制定的紫癜性肾炎的诊治循证指南(试行)诊断标准的紫癜性肾炎患儿共195人。首先,将研究对象分为四组:1.孤立性血尿组2.轻度蛋白尿组:24 h尿蛋白定量150 mg,但25 mg/(kg·d);3.中度蛋白尿组:24 h尿蛋白定量25~50 mg/(kg·d)4.肾病水平蛋白尿组:24 h尿蛋白定量≥50 mg/(kg·d)。其次,对临床病例进行指标筛选,其中反应临床特点的指标包括:性别、年龄、体重、病程(确诊过敏性紫癜至紫癜性肾炎患病的时间)、谷草转氨酶、谷丙转氨酶、尿素氮、肌酐和尿酸;反应一般炎症的指标包括:C反应蛋白、血小板计数、白细胞、中性粒细胞计数、血沉;反应特殊感染的指标包括:支原体、链球菌溶血素O。然后,将所收集的数据进行统计描述。采用SPSS 21.0软件,对四组不同尿蛋白水平间临床及炎性指标间的差异性进行比较,并对各临床指标以及炎性指标与尿蛋白定量间的相关性进行检验。从而,比较不同组别患儿肝、肾功能有无差异性,讨论不同尿蛋白水平患儿肝、肾功能等临床相关指标与尿蛋白有无相关性。比较不同组患儿一般感染情况及特殊感染情况有无差异性,并讨论不同感染指标与尿蛋白间有无关联性。结果:临床四组不同尿蛋白水平间临床指标肌酐及尿素氮有显著性差异,病程、谷草、谷丙转氨酶性及尿酸无统计学差异;炎性指标中的白细胞数、中性粒细胞数、血小板、C反应蛋白、抗链O、血沉均有显著性差异,支原体则无统计学差异性。临床指标中肌酐尿素氮与尿蛋白定量间有一定相关性;炎症各指标均与尿蛋白定量有一定相关性。结论:紫癜性肾炎在一定程度上与感染有关,其严重程度对于肾功能的影响较为密切。此外,炎症指标与紫癜肾炎尿蛋白定量具有一定相关性。
[Abstract]:Objective: Henoch-Schonlein purpura nephritis is the most serious clinical complication of Henoch-Schonlein purpura. All of them are studied from the perspective of the whole disease, which brings confusion to the individual treatment of children with different pathological levels and different proteinuria levels. This study is divided into groups with different levels of proteinuria to explain the clinical characteristics of Henoch-Schonlein purpura nephritis (HSPN). The correlation between urinary protein quantification and clinically-related inflammatory indexes was analyzed. To collect the evidence of diagnosis and treatment of Henoch-Schonlein purpura nephritis (HSPN), which was hospitalized in pediatric kidney and rheumatism immunity specialty of the second Hospital of Hebei Medical University from October 2014 to October 2016 and was in accordance with the nephrology section of the Chinese Academy of Pediatrics. There are 195 children with Henoch-Schonlein purpura nephritis according to the guidelines (trial). First of all, The subjects of the study were divided into four groups: 1. Isolated hematuria group 2.The urine protein in the mild albuminuria group was #number0# mg / 24 h, but the urinary protein in the moderate proteinuria group was 25: 24 h urinary protein quantification: 2550 mg/(kg 路dl 4.The proteinuria group with nephrotic level was equal to or greater than 50 mg/(kg 路dg in 24 h urinary protein. The clinical parameters including sex, age, body weight, course of disease (the time of diagnosis of Henoch-Schonlein purpura to Henoch-Schonlein purpura nephritis, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, urea nitrogen) were selected. Creatinine and uric acid; indicators that respond to general inflammation include: C reactive protein, platelet count, white blood cell, neutrophil count, erythrocyte sedimentation rate; response to specific infections include mycoplasma, streptococcus hemolysin O.Then, The data collected were statistically described. The differences of clinical and inflammatory indexes among four groups of different urinary protein levels were compared by SPSS 21.0 software. The correlation between the clinical and inflammatory indexes and the quantity of urinary protein was tested, so as to compare the difference of liver and kidney function in different groups of children, and discuss the liver of children with different levels of urinary protein. Whether there is correlation between renal function and urinary protein, and whether there are differences in general infection and special infection in different groups of children, Results: there were significant differences in creatinine and urea nitrogen among different urinary protein levels in the four groups. There was no significant difference in course of disease, aspartate, alanine aminotransferase and uric acid. There were significant differences in leukocyte count, neutrophil count, platelet C-reactive protein, anti-chain Oand erythrocyte sedimentation rate (ESR) in inflammatory indexes, but there was no significant difference in mycoplasma. There was a certain correlation between creatinine urea nitrogen and urinary protein quantification. Conclusion: purpura nephritis is related to infection to some extent, and its severity has a close effect on renal function. Inflammatory markers were correlated with urinary protein quantification in Henoch-Schonlein purpura nephritis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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