【作者】 雷蕾； 蒋瑾瑾；

【Author】 LEI Lei;JIANG Jin jin;Changhai Hospital Afiliated to the Second Military Medical University;

【机构】 第二军医大学附属长海医院；

【摘要】 目的:研究儿童过敏性紫癜的发病情况及临床特点。方法:总结126例HSP患儿的临床特点,了解其免疫学指标表达情况,对我院在2012年6月至2014年7月收治的过敏性紫癜病人临床表现分析,并与国内外相关研究进行对比分析;结果:1.2012年6月至2014年7月,我院的126例患儿男女比例为0.91:1,平均年龄为9.85±4.73,5-10岁年龄段是明显发病高峰,季节上相对集中于10-12月;2.发病原因以呼吸道感染为主,约37.30%的患者在发病前2周内有呼吸道感染史,而在59例无诱因病例中有15例在入院首日检查中发现血常规白细胞不同程度升高,体格检查发现存在呼吸道感染表现;3.从临床表现方面,首发症状有皮疹损害的有110例(87.3%),随着病程发展,100%的患儿均有不同程度的皮疹出现,这与其他多个报道结论:类似。首发有肾脏损害的有14例(11.11%)。但在整个病程中所有的患儿均出现皮疹,最终有肾脏损害的增加到49例(38.89%),低于湖南,但高于西藏及武汉地区(P值均<0.05)。其中10-15岁肾脏受累比例明显较其他年龄段高。出现伴发症状的时间平均为7天左右,皮疹出现约3天,肾功能异常出现约10天左右。4.在免疫功能方面,HSP患儿CD4细胞比例明显低于健康对照组(P=0.00),在各临床分组之间无明显差异。HSP患儿IgG、IgA、IgE水平明显高于健康对照组(P=0.00),IgM和C3的水平无明显差别(P=0.707,P=0.842),在各临床分组之间,单纯皮肤组的IgG和IgA水平明显低于肾脏受累组(P<0.01,P=0.045),但在肾脏受累组与非肾脏混合组之间无明显差异,IgE在三组不同临床分型之间均无明显差异。结论:隐匿性感染对HSP发病的影响不容忽视。相较于其他临床症状,肾脏受累一般较为隐匿,因此对于疾病早期尿常规,肾功能正常的患者仍有必要进行较长时间的动态监测。HSP患儿的免疫功能大多都有明显的紊乱,主要表现为CD4/CD8比值下降,IgG,IgA,IgE等免疫球蛋白水平升高。T细胞功能紊乱在HSP的发病过程中发挥重要作用,但在疾病的严重程度及进展方面并未发现明显作用,外周血IgA的水平与是否累及肾脏无明显相关性。更多还原

【Abstract】 Objective:In order to evaluate the clinical characteristics of children Henoch-Sch(o|¨)nlein purpura.Methods:To evaluate the clinical characteristics HSP,analyse the inmmulogical datas.Retrospective analysis the patient with HSP in Pediatric department in Changhai hospital from June 2012 to July 2014..Result:1.The ratio of male to female was 2.58:1.The patients were aged from 4 to 61(mean age:20.19 ± 11),And there was no significant seasonal variability of onset time.2.The incidence of rash was the highest(96.5%),which was similar to other reports.But the severity of lesions is worse than Wuhan report;The incidence of abdominal involvement was Lower than the report from abroad(P<0.05),but higher than Wuhan report(P=0.012).The incidence of renal involvement was similar to the Korean and Spain reports,but higher than Wuhan report(P<0.05).3.The incidence in children(≤ 20 yr) was higher than that in adult(>20 yr),and the peak age were at range of 5-10 yr and15-20 yr.And the 15-20 yr group accounted for 41.9%of 0-20 yr group.Compared to the group under 15 yr in our and other researches,the incidence rate of renal involvement was much higher in 15-20 yr group(P<0.05).Conclusion:Infection is the main inducement of HSP.Especially the hiding infection should be payed attention.Renal involvement is always imperceptible.So monitoring the urine and renal function at early stage is very important.The inbalance of T cells plays an important role in the HSP,but no effect was observed in the severity and progress of the disease.No relevance was observed between IgA level in the peripheral blood and the renal involvement.更多还原