摘要
目的分析过敏性紫癜(HSP)儿童发病初期肾损伤的危险因素,并观察血液灌流(HP)治疗HSP的临床效果及对早期肾损伤的作用。方法选择2018年5月至2019年5月在西安交通大学第一附属医院和西安市儿童医院住院治疗的234例HSP患儿为研究对象,根据诊断分为肾损伤(HSPN)组(78例)和非肾损伤(NHSPN)组(156例),分析两组一般人口学资料、出生喂养史、临床症状和相关检验指标情况;将肾损伤组患儿随机分为灌流组(38例)和对照组(40例),观察两组皮疹消退、腹痛、关节肿痛、便血症状缓解时间,检测治疗前和治疗1d、2d、3d后尿微量白蛋白(Alb)、尿α1微球蛋白(α1-MG)、尿β2微球蛋白(β2-MG)的含量,并对数据进行统计分析。结果影响HSP肾损伤发生的单因素分析显示,HSP肾损伤发生率在年龄、性别、季节方面差异均有统计学意义(χ^(2)值分别为18.15、16.67、18.72,P<0.05);HSP肾损伤发生率在出生体重、母乳喂养时间方面差异均有统计学意义(χ^(2)值分别为21.57、9.63,P<0.05);肾损伤组患儿出现腹痛、上肢/面部皮疹、皮疹反复时间≥4周、皮疹反复次数≥3次的发生率及D-二聚体异常率与非肾损伤组比较差异均有统计学意义(χ^(2)值分别为16.58、6.08、10.48、12.24、13.32,P<0.05)。Logistic逐步回归分析显示,年龄≥9岁、男性HSP患儿发生肾损伤的风险分别是<9岁、女性患儿的5.47和2.36倍(P<0.05);出现腹痛、上肢/面部皮疹症状患儿发生HSP肾损伤的风险分别是无该症状患儿的4.18和3.69倍(P<0.05);检验指标D-二聚体异常的患儿发生HSP肾损伤的风险是指标正常患儿的3.61倍(P<0.05)。灌流组患儿皮疹消退时间及腹痛、关节肿痛和便血症状的缓解时间均明显短于对照组(t值分别为8.87、9.05、6.51、7.74,P<0.05);治疗后灌流组和对照组患儿尿液Alb、α1-MG、β2-MG含量均随治疗时间的延长而降低(F=3.38~341.14,P<0.05);不同治疗时期灌流组�
Objective To analyze the risk factors of renal injury in children with Henoch-Sch9 nlein purpura(HSP) during the early phase of onset, and observe the clinical effect of hemoperfusion(HP) in the treatment of HSP and its effect on early renal injury.Methods The 234 children with HSP,who were hospitalized in the First Affiliated Hospital of Xi′an Jiaotong University and Xi′an Children′s Hospital from May 2018 to May 2019,were selected as the research subjects.According to the diagnosis, they were divided into the renal injury(HSPN) group(78 cases) and the non-renal injury(NHSPN)group(156 cases).The general demographic data, birth feeding history, clinical symptoms and related test indicators of the two groups were analyzed.The children in the HSPN group were randomly divided into the perfusion group(38 cases) and the control group(40 cases).The time of rash resolution, abdominal pain, joint swelling and pain and bloody stool symptom relief time were observed, and the content of albumin(Alb),α1-microglobulin(α1-MG) and β2-microglobulin(β2-MG) in urine before treatment and 1 d, 2 d, 3 d after treatment were detected and analyzed.Results The results of univariate analysis on the influencing factors of the occurrence of HSP renal injury showed that the incidences of HSP renal injury were statistically significantly different in age, gender and season(χ^(2)=18.15,16.67 and 18.72,respectively, P<0.05).The incidences of HSP renal injury were statistically significantly different in birth weight and breastfeeding time(χ^(2)=21.57 and 9.63,respectively, P<0.05).The abdominal pain, upper limb/face rash symptoms, rash recurrence time ≥4 weeks, the occurrence rate of skin rash recurrence ≥3 times and the rate of abnormal D-dimer in the renal injury group were higher than the non-renal injury group(χ^(2)=16.58,6.08,10.48,12.24 and 13.32,respectively, P<0.05).The Logistic stepwise regression analysis results showed that the risk of HSP renal injury in children who were aged ≥9 years and male were 5.47 and 2.36
作者
王宁
李志娟
黄燕萍
WANG Ning;LI Zhijuan;HUANG Yanping(Department of Pediatrics,the First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Xi’an 710061,China;Department of Pediatric Medicine,Xi'an International Medical Center Hospital,Shaanxi Xi'an 7100109,China;Department of Nephrology,Xi’an Children's Hospital,Shaanxi Xi'an 710003,China)
出处
《中国妇幼健康研究》
2022年第1期104-111,共8页
Chinese Journal of Woman and Child Health Research
关键词
过敏性紫癜
血液灌流
疗效
早期肾损伤指标
Henoch-Sch9nlein purpura
hemoperfusion
efficacy
indicators of early renal injury
