本文選題：過敏性紫癜　切入點：紫癜性腎炎　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:紫癜性腎炎是過敏性紫癜最嚴重的臨床并發(fā)癥,它嚴重影響患兒的預后及生活質(zhì)量,多項有關紫癜性腎炎臨床特點和臨床相關炎性指標的研究,都以疾病整體的角度去研究,這就為不同病理水平以及不同蛋白尿水平患兒的個體化治療帶來困惑。本研究則以不同蛋白尿水平進行分組,闡述紫癜性腎炎的臨床特點,并對尿蛋白定量與臨床相關炎性指標間的相關性進行分析。方法:采用系統(tǒng)回顧的分析方法,收集自2014年10月至2016年10月在河北醫(yī)科大學第二醫(yī)院兒科腎臟及風濕免疫專業(yè)住院且符合中華醫(yī)學會兒科學分會腎臟病學組于2009年制定的紫癜性腎炎的診治循證指南(試行)診斷標準的紫癜性腎炎患兒共195人。首先,將研究對象分為四組:1.孤立性血尿組2.輕度蛋白尿組:24 h尿蛋白定量150 mg,但25 mg/(kg·d);3.中度蛋白尿組:24 h尿蛋白定量25~50 mg/(kg·d)4.腎病水平蛋白尿組:24 h尿蛋白定量≥50 mg/(kg·d)。其次,對臨床病例進行指標篩選,其中反應臨床特點的指標包括:性別、年齡、體重、病程(確診過敏性紫癜至紫癜性腎炎患病的時間)、谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、尿素氮、肌酐和尿酸;反應一般炎癥的指標包括:C反應蛋白、血小板計數(shù)、白細胞、中性粒細胞計數(shù)、血沉;反應特殊感染的指標包括:支原體、鏈球菌溶血素O。然后,將所收集的數(shù)據(jù)進行統(tǒng)計描述。采用SPSS 21.0軟件,對四組不同尿蛋白水平間臨床及炎性指標間的差異性進行比較,并對各臨床指標以及炎性指標與尿蛋白定量間的相關性進行檢驗。從而,比較不同組別患兒肝、腎功能有無差異性,討論不同尿蛋白水平患兒肝、腎功能等臨床相關指標與尿蛋白有無相關性。比較不同組患兒一般感染情況及特殊感染情況有無差異性,并討論不同感染指標與尿蛋白間有無關聯(lián)性。結(jié)果:臨床四組不同尿蛋白水平間臨床指標肌酐及尿素氮有顯著性差異,病程、谷草、谷丙轉(zhuǎn)氨酶性及尿酸無統(tǒng)計學差異;炎性指標中的白細胞數(shù)、中性粒細胞數(shù)、血小板、C反應蛋白、抗鏈O、血沉均有顯著性差異,支原體則無統(tǒng)計學差異性。臨床指標中肌酐尿素氮與尿蛋白定量間有一定相關性;炎癥各指標均與尿蛋白定量有一定相關性。結(jié)論:紫癜性腎炎在一定程度上與感染有關,其嚴重程度對于腎功能的影響較為密切。此外,炎癥指標與紫癜腎炎尿蛋白定量具有一定相關性。
[Abstract]:Objective: Henoch-Schonlein purpura nephritis is the most serious clinical complication of Henoch-Schonlein purpura. All of them are studied from the perspective of the whole disease, which brings confusion to the individual treatment of children with different pathological levels and different proteinuria levels. This study is divided into groups with different levels of proteinuria to explain the clinical characteristics of Henoch-Schonlein purpura nephritis (HSPN). The correlation between urinary protein quantification and clinically-related inflammatory indexes was analyzed. To collect the evidence of diagnosis and treatment of Henoch-Schonlein purpura nephritis (HSPN), which was hospitalized in pediatric kidney and rheumatism immunity specialty of the second Hospital of Hebei Medical University from October 2014 to October 2016 and was in accordance with the nephrology section of the Chinese Academy of Pediatrics. There are 195 children with Henoch-Schonlein purpura nephritis according to the guidelines (trial). First of all, The subjects of the study were divided into four groups: 1. Isolated hematuria group 2.The urine protein in the mild albuminuria group was #number0# mg / 24 h, but the urinary protein in the moderate proteinuria group was 25: 24 h urinary protein quantification: 2550 mg/(kg 路dl 4.The proteinuria group with nephrotic level was equal to or greater than 50 mg/(kg 路dg in 24 h urinary protein. The clinical parameters including sex, age, body weight, course of disease (the time of diagnosis of Henoch-Schonlein purpura to Henoch-Schonlein purpura nephritis, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, urea nitrogen) were selected. Creatinine and uric acid; indicators that respond to general inflammation include: C reactive protein, platelet count, white blood cell, neutrophil count, erythrocyte sedimentation rate; response to specific infections include mycoplasma, streptococcus hemolysin O.Then, The data collected were statistically described. The differences of clinical and inflammatory indexes among four groups of different urinary protein levels were compared by SPSS 21.0 software. The correlation between the clinical and inflammatory indexes and the quantity of urinary protein was tested, so as to compare the difference of liver and kidney function in different groups of children, and discuss the liver of children with different levels of urinary protein. Whether there is correlation between renal function and urinary protein, and whether there are differences in general infection and special infection in different groups of children, Results: there were significant differences in creatinine and urea nitrogen among different urinary protein levels in the four groups. There was no significant difference in course of disease, aspartate, alanine aminotransferase and uric acid. There were significant differences in leukocyte count, neutrophil count, platelet C-reactive protein, anti-chain Oand erythrocyte sedimentation rate (ESR) in inflammatory indexes, but there was no significant difference in mycoplasma. There was a certain correlation between creatinine urea nitrogen and urinary protein quantification. Conclusion: purpura nephritis is related to infection to some extent, and its severity has a close effect on renal function. Inflammatory markers were correlated with urinary protein quantification in Henoch-Schonlein purpura nephritis.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.9

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