儿童过敏性紫癜消化道出血相关实验室指标分析

发布时间：2018-04-29 01:16

本文选题：过敏性紫癜 + 消化道出血　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:研究儿童过敏性紫癜(Henoch-Schonlein Purpura,HSP)临床症状与相关实验室指标的关系,探讨HSP患儿相关实验室指标对HSP发生消化道出血的预测价值,以尽早识别可能发生不良并发症的患儿,以便医务人员尽早发现,尽早干预,从而降低HSP患儿发生消化道出血的风险。方法:收集2014年5月至2016年5月期间在兰州大学第一医院就诊,首次诊断并收入院治疗的HSP患儿。以148例处于急性期,未经过糖皮质激素及免疫抑制剂治疗,并排外其他感染的HSP患儿为HSP组。同时收集77例因腹痛入院,但经检查后无任何器质性病变的患儿为对照组。两组均在入院当日采集血样,进行血常规、血沉(Erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)等的检测。收集并记录患儿的性别、年龄、住院天数、临床症状、体征及激素的使用情况,并从相关化验检查结果中提取白细胞计数(White blood cell count,WBC)、淋巴细胞绝对值、中性粒细胞绝对值、血红蛋白(Hemoglobin,Hb)、血小板计数((Platelet count,PLT)、平均血小板体积(Mean platelet volume,MPV)、CRP及ESR的值,计算出中性粒细胞与淋巴细胞绝对值的比值(Neutrophils to lymphocytes ratio,NLR)。结果:(1)本研究HSP组共纳入148例HSP患儿,其中男81例,女67例,男与女比例为1.2:1;年龄2~16岁,平均年龄7.7±2.8岁;住院天数2~27天,平均住院6.5(5~9)天;大多冬春季发病;急性期以皮肤紫癜作为首发症状的有143例,以腹痛首发的有3例,以关节肿痛首发的有2例;HSP患儿合并消化道出血者39例,占26.4%,其中因并发肠套叠,并施行外科手术的有1例;经明确诊断后使用激素治疗的患儿111例,占总人数的75%。(2)HSP组WBC、中性粒细胞绝对值、NLR、PLT与对照组相比明显升高,淋巴细胞绝对值与对照组相比明显降低,差异具有统计学意义。(3)HSP消化道出血组的WBC、中性粒细胞绝对值、NLR和CRP较非消化道出血组明显升高,淋巴细胞绝对值较非消化道出血组明显降低,差异具有统计学意义。(4)HSP患儿的临床评分与实验室指标WBC(r=0.344,P0.001)、中性粒细胞绝对值(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)呈显著正相关。(5)经Logistic逐步回归分析,CRP及NLR是HSP消化道出血的独立危险因素。(6)根据ROC曲线下面积结果,与NLR相比,CRP是HSP消化道出血的潜在的更有效的预测指标。结论:CRP7.25mg/L及NLR3.43可作为预测儿童HSP消化道出血的简易指标,尤其对腹型HSP并发消化道出血的早期筛查可能具有更好的价值。
[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 卤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.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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