【作者】 丁莉；

【导师】 黄洁；

【作者基本信息】 苏州大学 ， 儿科学， 2022， 硕士

【摘要】 目的:通过收集过敏性紫癜患儿的临床资料,将发病因素、临床表现、体质、肾损害相关因素等进行统计数据分析,提高对儿童过敏性紫癜及紫癜性肾炎的认识,为本病的预防、诊治提供参考,做到早预防、早治疗。方法:回顾性研究2017年1月-2021年12月收治于宿迁市中医院儿科病区诊断为过敏性紫癜患儿的临床资料。根据纳入及排除标准最终选取377例患儿,收集这些患儿临床资料,包括将发病因素、临床表现、体质、肾损害相关因素等,通过EXCEL、SPSS 26.0等软件对病案数据进行描述性分析及Logistic回归分析。结果:1.一般资料:377例过敏性紫癜患儿中,男性229例(60.74%),女性148例(39.26%),男女比例为1.55:1。发病年龄最小为2岁,年龄最大为14岁,发病平均年龄为7.86±2.35岁。学龄期210例(55.70%),学龄前期108例(28.65%)。发病季节以春秋季节多见,春季118例(31.30%),夏季59例(15.65%),秋季106例(28.12%),冬季 94 例(24.93%)。2.发病诱因:95例(25.20%)患儿发病前2周内有呼吸道感染史;其他有食物过敏、疫苗接种等共55例(14.59%);227例(60.21%)的患儿未明确发病诱因。3.临床表现:(1)皮疹:369例(97.88%)在初次就诊时出现典型皮肤皮疹表现,其余8例(2.12%)在后期出现皮疹。156例(41.38%)患儿皮疹反复3次及以上。(2)消化道症状:114例(30.24%)患儿出现胃肠道症状,其中学龄期患儿74例(64.91%)。(3)关节症状:103例(27.32%)患儿出现关节症状,其中学龄期患儿67例(65.05%)。(4)肾脏损害:377例中,有102例(27.06%)患儿诊断为紫癜性肾炎,临床表现以孤立性血尿型、孤立性蛋白尿多见。其中,102例紫癜性肾炎中,有39例(38.24%)患儿进行了肾活检,病理结果以Ⅱb级最多,Ⅲa级、Ⅱa级次之。4.辅助检查:377例过敏性紫癜患儿中,256例患儿(67.90%)血常规结果提示白细胞升高,CRP升高者208例(55.17%),ASO升高98例(25.99%),79例患儿肺炎支原体IgM阳性(20.95%),246例患儿(65.25%)患儿血沉升高,341例(90.45%)患儿D-二聚体升高。377例过敏性紫癜患儿过敏原检测中,牛奶阳性率最高,为181例(61.3%),其次为鸡蛋过敏89例(30.17%)。132例(35.01%)患儿血清IgA增高,HSPN 组 76 例(57.58%),非 HSPN 组 56 例(42.42%),HSPN 组明显高于非 HSPN组。5.体质结果:阴虚质患儿89例(23.61%),阴虚质人数最多,其次为阳热质78例(20.69%)。体质与年龄、皮疹反复次数、CRP、血沉、抗O、IgA有一定的相关性。6.多因素分析:经logistic回归性分析,学龄期儿童、皮疹反复3次以上、伴随消化道症状、阴虚质属于过敏性紫癜肾损害的独立危险因素。结论:1.在377例儿童过敏性紫癜中,性别差异上男孩多于女孩;发病年龄以学龄期为多;发病季节以春秋季节多见。2.过敏性紫癜的病因尚不明确,考虑可能与呼吸道感染、食物过敏等因素有关。其中呼吸道感染是目前HSP最常见的诱因,其次为食物过敏。3.过敏性紫癜患儿的体质以阴虚质、阳热质居多,阴虚质与学龄期、皮疹反复≥3次、CRP、血沉、抗O、IgA有一定的相关性。4.学龄期儿童、皮疹反复3次以上、伴随消化道症状、阴虚质属于过敏性紫癜肾损害的独立危险因素。更多还原

【Abstract】 Objective:Through the collection of clinical data of children with Henoch-Schonlein Purpura,statistical analysis of pathogenic factors,clinical manifestations,physical fitness,kidney damage-related factors,etc.,to improve the understanding of children’s HenochSchonlein Purpura and Purpura Nephritis,and to prevent,diagnose and treat the disease Provide reference to achieve early prevention and early treatment.Method:The clinical data of children diagnosed with Henoch-Schonlein Purpura who were admitted to the Pediatric Ward of Suqian Hospital of Traditional Chinese Medicine from January 2017 to December 2021 were retrospectively studied.According to the inclusion and exclusion criteria,377 cases of children were finally selected,and the clinical data of these children were collected,including pathogenic factors,clinical manifestations,physical fitness,kidney damage-related factors,etc.,and the medical record data were descriptively analyzed and analyzed by software such as EXCEL and SPSS 26.0.Logistic regression analysis.Results:1.General information:Among the 377 children with allergic purpura,there were 229 males(60.74%)and 148 females(39.26%),with a male to female ratio of 1.55:1.The youngest age of onset was 2 years old,the oldest was 14 years old,and the average age of onset was 7.86±2.35 years old.210 cases(55.70%)of school age,108 cases(28.65%)of preschool age.Spring and autumn were the most common disease seasons,with 118 cases(31.30%)in spring,59 cases(15.65%)in summer,106 cases(28.12%)in autumn,and 94 cases(24.93%)in winter.2.Incidence cause:95 cases(25.20%)had a history of respiratory tract infection within 2 weeks before the onset;55 cases(14.59%)had other food allergies,vaccinations,etc.;227 cases(60.21%)had no clear cause.3.Clinical manifestations:(1)Rash:369 cases(97.88%)had a typical skin rash at the first visit,and the remaining 8 cases(2.12%)had a rash at a later stage.156 cases(41.38%)had rash repeated 3 times or more.(2)Gastrointestinal symptoms:114 children(30.24%)had gastrointestinal symptoms,including 74 children of school age(64.91%).(3)Joint symptoms:103 children(27.32%)had joint symptoms,including 67 children of school age(65.05%).(4)Kidney damage:Among the 377 cases,102 cases(27.06%)were diagnosed as purpura nephritis,and the clinical manifestations were mostly isolated hematuria and isolated proteinuria.Among them,among the 102 cases of purpura nephritis,39 cases(38.24%)underwent renal biopsy,and the most pathological results were grade Ⅱ b,followed by grade Ⅲa and grade Ⅱa.4.Auxiliary examination:Among the 3 77 children with Henoch-Schonlein Purpura,256 cases(67.90%)had elevated white blood cells,208 cases(55.17%)with elevated CRP,98 cases(25.99%)with elevated ASO,79 Mycoplasma pneumoniae IgM was positive in 1 case(20.95%),erythrocyte sedimentation rate was elevated in 246 cases(65.25%),and Ddimer was elevated in 341 cases(90.45%).Among the 377 children with allergic purpura,the positive rate of milk was the highest in 181 cases(61.3%),followed by egg allergy in 89 cases(30.17%).Serum IgA increased in 132 cases(35.01%),76 cases(57.58%)in the HSPN group and 56 cases(42.42%)in the non-HSPN group,and the HSPN group was significantly higher than the non-HSPN group.5.Constitution results:89 cases(23.61%)of children with Yin-deficiency constitution,the largest number of children with Yin-deficiency constitution,followed by 78 cases(20.69%)of Yang-heat constitution.There is a certain correlation between constitution and age,repeated times of rash,CRP,erythrocyte sedimentation rate,anti-O and IgA.6.Multivariate analysis:After logistic regression analysis,school-age children,repeated rash for more than 3 times,accompanied by gastrointestinal symptoms,and yin deficiency were independent risk factors for allergic purpura renal damage.Conclusions:1.Among the 377 cases of allergic purpura in children,there were more boys than girls in terms of gender difference;the age of onset was mostly in school age;the onset season was mostly in spring and autumn.2.The etiology of Henoch-Schonlein purpura is not yet clear,and it may be related to respiratory tract infection,food allergy and other factors.Respiratory tract infection is currently the most common cause of HSP,followed by food allergy.3.The constitution of children with Henoch-Schonlein purpura is mostly yin-deficiency constitution and yang-heat constitution,and there is a certain correlation between constitution and age,repeated times of rash,CRP,erythrocyte sedimentation rate,anti-O and IgA.4.School-age children,repeated rash for more than 3 times,accompanied by gastrointestinal symptoms,and yin deficiency are independent risk factors for allergic purpura renal damage.更多还原