【作者】 郑丹；

【导师】 李廷玉；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2020， 硕士

【摘要】 目的:分析系统性红斑狼疮(systemic lupus erythematosus,SLE)儿童的体格生长及反映营养问题相关指标,评估其营养状况。方法:采用回顾性病例分析,对符合纳入标准的66例系统性红斑狼疮住院患儿信息进行采集,例如:病初及病程中的体重及身高,同时计算身体质量指数(BMI),以九省市参考值做参考,入院时及治疗后静脉血血红蛋白(HB)及白蛋白(ALB),病程中甘油三酯水平及骨密度,评估疾病活动度采用系统性红斑狼疮疾病活动指数(SLEDAI-2000),通过病史采集了解治疗情况。结果:66例SLE患儿在入院时及病程中发现低体重者为13.6%,矮小者为16.7%,肥胖者为3%,超重者为15.2%,消瘦者为7.6%,比较男女性患儿体重、身高、BMI,差异均无统计学意义。贫血者占92.4%,低ALB血症者占80.3%,中重度贫血或低ALB血症患儿分别占42.4%、53.1%,经治疗后HB、ALB水平较前升高(P=0.023、0.002)。疾病活动度以中重度活动为主,分别占37.9%和53%。经过检测的48例患儿中高甘油三酯血症占72.9%,中、重度高甘油三酯血症者分别占54.2%、2.1%,39例患儿中25.6%骨量减少,33.3%骨量严重下降。补充ALB、使用免疫抑制剂及丙种球蛋白均与低ALB血症改善存在正相关关系(Kendall’s tau-b相关系数=0.341、0.310、0.348,P=0.006、0.012、0.005),激素冲击治疗与低ALB血症或贫血改善无显著相关关系,且贫血改善与输血、血浆置换、使用免疫抑制剂及丙种球蛋白均无显著相关关系。疾病活动度和ALB水平为负相关关系(spearman系数为-0.328,P=0.007),与HB水平、甘油三酯水平及BMI无关。结论:SLE住院患儿营养不良、贫血及低白蛋白血症检出率较高,且存在高甘油三酯血症和骨量下降等问题,儿科医生在治疗原发病时需重视患儿营养情况并积极进行干预。更多还原

【Abstract】 Objective: According to analyzing the index about physical growth and nutrition,to evaluate the nutritional status in children with systemic lupus erythematosus(SLE).Methods: A retrospective analysis collected the information of 66 SLE children met the inclusion criteria in hospital to assess the anthropometric data,clinical laboratory findings,disease activity,and the association between index mentioned above and treatment therapy.Results: At the time of admission or in the course of disease,among66 SLE children,13.6% were with low weight,16.7% were short stature,3% was classified as obesity,15.2% as overweight and 7.6% as underweight.In addition,the morbidity of anemia and hypoalbuminemia were 92.4% and 80.3%,42.4% and 53.1% were moderate to severe anemia and hypoalbuminemia,the level of which were both improved after treatment(P=0.023、0.002).The activity degree of disease was mainly moderate to severe,accounting for 37.9% and 53%,respectively.72.9%had hypertriglyceridemia in the 48 SLE children with lipid testing,whichin 54.2% of moderate and 2.1% of severe.In 39 patients examined,25.6%were osteopenia and 33.3% were severe osteopenia.The use of albumin,immunosuppressants and gamma globulin were positively associated with the improvement of hypoalbuminemia(Kendall ’s tau-b correlation coefficient is 0.341,0.310 and 0.348,P=0.006,0.012 and 0.005).Anemia had no significant correlation with blood transfusion,plasma exchange,the use of hormone shock,immunosuppressants and gamma globulin.The disease activity had negetive associated with albumin level(Spearman coefficient was-0.328,P=0.007),but no positively association with HB level,triglyceride level or BMI.Conclusion:The morbidity of malnutrition,anemia and hypoalbuminemia in hospitalized SLE children are high,and there are problems such as hypertriglyceridemia and osteopenia as well.Pediatricians should pay more attention to the nutritional status of SLE children and nutritional intervention should be a part in treating SLE patients.更多还原