521例儿童过敏性紫癜临床回顾性研究

发布时间：2018-06-24 12:27

本文选题：过敏性紫癜 + 儿童　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:探讨儿童过敏性紫癜的发生发展、临床表现、分型、中药辨治规律及治疗与预后等,以提高对本病的认识,为其诊治提供临床依据。方法:通过对2010年12月31日至2015年12月31日期间到云南中医学院第一附属医院(云南省中医医院)儿科住院并符合纳入标准的儿童过敏性紫癜的一般情况(年龄、性别及发病季节)、发病诱因、临床表现、实验室检查、分型、中药使用情况、治疗及预后等方面进行回顾性研究,采用Excel及SPSS20.0软件统计分析。结果:1.一般情况:本研究共收集521例儿童过敏性紫癜,平均发病年龄为(8.25±2.87)岁,好发年龄段为学龄组(≥7岁且12岁),共267例(51.24%)。男女之比为1.43:1。高发于春冬季,占全年的57.97%。2.发病诱因:呼吸道感染为儿童过敏性紫癜的主要诱因,占发病总数的55.28%;食入性过敏、药物性过敏或其他因素过敏的患儿占9.02%;具有家族遗传史病例7例,占1.34%;其余患儿发病原因未明。3.临床表现:521例过敏性紫癜患儿在住院期间出现了皮肤紫癜,其中462例以皮肤紫癜为首发症状;182例出现消化道症状;121例出现关节症状;肾脏受累157例,与消化道症状及关节症状无明显相关性(p0.05),以学龄组(≥7岁且12岁)为高发年龄段(p0.05)。4.实验室检查:白细胞计数升高215例;C反应蛋白升高237例;血小板升高187例;肺炎支原体阳性69例;嗜肺军团菌阳性42例;腺病毒阳性37例;呼吸道合胞病毒阳性31例;甲、乙或(和)副型流感病毒阳性29例;肺炎衣原体阳性6例;抗链球菌溶血素O阳性84例;粪便隐血阳性72例;纤维蛋白原升高174例;D-二聚体升高122例。5.分型:西医临床分型:单纯型紫癜163例;腹型紫癜94例;关节型紫癜57例;肾型紫癜88例;混合型紫癜119例。中医辨证分型:风热伤络证225例;血热伤络证103例;湿热伤络证92例;肠胃积热证59例;气虚血瘀证21例;阴虚火旺证13例;脾肾阳虚证8例。6.中药辨治规律:常用的中药前十分别为:甘草、荆芥、防风、赤芍、小蓟、绿豆、赤小豆、炒黑豆、连翘、金银花。20味高频药物聚类分为:C1:赤小豆、炒黑豆、绿豆、连翘、金银花、白茅根;C2:苍术、黄柏、水牛角末、紫草、薏苡仁、牡丹皮、仙鹤草、牛膝、茜草;C3:赤芍、小蓟、防风;C4:甘草、荆芥。临床用药以清热解毒类、辛温解表类、清热凉血类及凉血止血类及补气类药最为常用。药物类别以治“热”、治“瘀”、治“毒”、治“风”药、治“湿”、治“虚”等相须为用,共同治疗。7.治疗及预后:521例过敏性紫癜患儿均以中医综合治疗为主,164例患儿配合西医进行治疗。经治疗后,临床治愈120例,好转396例,未愈5例,总有效率99.04%。结论:1.儿童过敏性紫癜好发于学龄期,男性患儿多见,高发于春冬季。2.呼吸道感染为儿童过敏性紫癜的主要诱因。3.临床表现中首发症状以特征性皮肤紫癜最为常见,其次为消化道及关节症状;年龄段为(≥7岁且12岁)过敏性紫癜患儿肾脏更容易受累。4.西医分型以单纯型紫癜最常见,其次为混合型紫癜;中医证型则以风热伤络证最常见,气虚血瘀证、阴虚火旺证及脾肾阳虚证较少见。各西医分型中中医证型以风热伤络证最多;风热伤络证对应西医临床分型又以单纯型紫癜为主。5.瘀血贯穿本病的始终,病因常见外有风热之邪,内有火热之毒;其主要病机为脉络受损,血液外溢而发为儿童过敏性紫癜。儿童过敏性紫癜常见于风邪、热毒及瘀血,多治以疏风清热解毒,凉血止血化瘀,以清热解毒类、辛温解表类、清热凉血类及凉血止血类及补气类最为常用。用药以治“热”、治“瘀”、治“毒”药为主,并辅以治“风”、治“湿”、治“虚”等药,符合刘以敏主任“热毒”及“瘀血”致病的观点。6.我院以中药汤剂、中成药、中药注射液及中医外治法的综合疗法治疗儿童过敏性紫癜效果明显,但部分严重的腹型紫癜和紫癜性肾炎患儿仍需中西医结合治疗提高疗效。
[Abstract]:Objective: To explore the occurrence and development of children's Henoch Schonlein purpura, clinical manifestations, classification, rule of treatment and treatment and prognosis of traditional Chinese medicine, so as to improve the understanding of this disease and provide clinical basis for its diagnosis and treatment. Methods: through the period from December 31, 2010 to December 31, 2015 to the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine (Yunnan Provincial Hospital of traditional Chinese Medicine) paediatrics The hospital conforms to the general conditions of children's allergic purpura (age, sex and season), the causes of the disease, the clinical manifestation, the laboratory examination, the typing, the use of traditional Chinese medicine, the treatment and the prognosis, and the statistical analysis of Excel and SPSS20.0 soft parts. Results: 1. general situation: 521 cases were collected in this study. The average age of onset of children's Henoch Schonlein purpura was (8.25 + 2.87) years, the good onset age group was school age group (7 years old and 12 years old), and 267 cases (51.24%). The ratio of male and female was 1.43:1. high in spring and winter, which accounted for the cause of 57.97%.2.. The respiratory infection was the main cause of children's allergic purpura, accounting for 55.28% of the total incidence of the disease. Children with allergy or other allergies accounted for 9.02%, with family genetic history of 7 cases, accounting for 1.34%; the other children were unaware of the clinical manifestations of.3.: 521 cases of Henoch Schonlein purpura appeared skin purpura during hospitalization, 462 cases with skin purpura as the first symptom, 182 cases of digestive tract symptoms, 121 cases of joint symptoms; kidneys; kidney There were 157 cases of involvement in the digestive tract symptoms and joint symptoms (P0.05). In the school age group (7 years old and 12 years old), the high onset age group (P0.05).4. laboratory examination: 215 cases of white blood cell count increase, 237 cases of C reactive protein increase, 187 cases of platelets, 69 Mycoplasma pneumophila positive, 42 cases of Legionella pneumophila, 37 cases of adenovirus positive, and 37 cases of adenovirus. 31 cases of DDV positive, 29 cases of influenza virus positive, 6 cases of Chlamydia pneumoniae, 84 cases of anti streptococcal hemolysin O positive, 72 cases of fecal occult blood, 174 cases of fibrinogen, and 122.5. types in the D- two polymer, 163 cases of purpura simple purpura, 94 cases of abdominal purpura and 57 cases of joint purpura. 88 cases of renal purpura; 119 cases of mixed purpura; TCM syndrome differentiation: 225 cases of wind and heat injury and collateral syndrome; 103 cases of blood heat injury and collateral syndrome; 92 cases of damp heat injury and collateral syndrome; 59 cases of heat accumulation of stomach and stomach; 21 cases of qi deficiency and blood stasis syndrome; 13 cases of yin deficiency and blood stasis syndrome; 8 cases of spleen kidney yang deficiency syndrome: 8 cases of.6. traditional Chinese medicine: Ten: licorice, brimming, red peony root, thistle, green Bean, red bean, fry black bean, forsythia forsythia, and honeysuckle.20 high frequency drug cluster divided into: C1: red bean, fried black bean, mung bean, forsythia, honeysuckle root; C2: Atractylodes, cypress, buffalo corner, purple grass, coix seed, peony, crane, Achyranthes, alizegrass; C3: red peony, thistle, anti wind; C4: licorice, Jing. Clinical use of antipyretic, liquorice, Xinwen digestion class, C4: liquorice. The most commonly used medicine of clearing blood and cooling blood, cooling blood and stopping blood and enriching qi is the most common medicine. The drugs are treated with "heat", "stasis", "poison", "wind" medicine, "dampness" and "deficiency" in treating.7. treatment and prognosis: 521 cases of anaphylactoid purpura are treated mainly by comprehensive treatment of Chinese medicine and 164 cases with western medicine. After treatment, 120 cases were cured, 396 cases were improved, 5 cases were not healed, the total effective rate was 99.04%. conclusion: 1. children with anaphylactoid purpura were found in school age, male children were more common, and.2. respiratory tract infection was the main cause of allergic purpura in children in spring and winter. The most common symptom in.3. was characteristic skin purpura, followed by the elimination of characteristic skin purpura. The kidneys of children with anaphylactoid purpura (aged 7 and 12 years old) were more likely to be affected by the age group. The most common type of.4. western medicine was simple purpura, followed by mixed purpura; the TCM syndrome type was the most common, Qi deficiency and blood stasis syndrome, the deficiency of the deficiency of fire and the deficiency of the spleen and kidney yang. The syndromes of heat injury and collaterals are the most, and the syndromes of wind and heat injury collaterals correspond to the clinical classification of Western medicine and pure purpura mainly.5. blood stasis throughout the disease. The pathogenic factors are common outside the pathogenic wind and fever, and the main pathogenesis is choroid damage, blood spillover and anaphylactoid purpura. It is the most common use of clearing heat and relieving blood stasis, relieving blood and removing blood stasis by cooling blood and relieving blood and relieving blood stasis. It is most commonly used in the class of clearing heat and detoxifying the blood, clearing blood and cooling blood and relieving blood and Qi. The drugs are used to treat "heat", cure "stasis" and cure "poison" drugs, supplemented by treating "wind", treating "dampness", and treating "deficiency", which conforms to the cause of "hot poison" and "blood stasis" of director Liu Yimin. .6. in our hospital, the effect of Chinese medicine decoction, Chinese traditional medicine, traditional Chinese medicine injection and traditional Chinese medicine treatment on children's Henoch Schonlein purpura is obvious, but some severe abdominal purpura and Henoch Schonlein nephritis still need the combination of Chinese and Western medicine to improve the curative effect.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

【参考文献】