难治性过敏性紫癜25例  

Clinical Analysis of Refractory Henoch-Schonlein Purpura in 25 Children

作　　者：罗洁[1] 邹敏[1] 徐琴英[1] 闵月[1] 李晓忠[1] 

机构地区：[1]苏州大学附属儿童医院肾内科,江苏苏州215003

出　　处：《实用儿科临床杂志》2009年第21期1643-1645,共3页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金项目资助(30271234)

摘　　要：目的探讨儿童难治性过敏性紫癜(HSP)的临床特点,以提高对该病的认识。方法回顾性分析苏州大学附属儿童医院2005年1月-2008年1月收治的25例难治性HSP患儿的临床资料、实验室检查,总结其发病特点、临床表现、治疗及预后,并与同期50例一般HSP患儿(对照组)进行比较,应用SPSS12.0软件进行统计学分析。结果难治性HSP患儿25例均有不同程度的消化道症状,年龄4～8岁17例(68%),腹痛持续时间较对照组显著延长(P<0.01),16例(64%)有反复消化道出血,2例并肠套叠,4例误诊为急性阑尾炎。25例难治性HSP患儿肾脏受损发生率(44%)显著高于对照组(8%)(P<0.01),24h尿蛋白定量和尿微量蛋白升高率与对照组比较均有显著性差异(Pa<0.01)。25例难治性HSP患儿血淋巴细胞亚群CD3、CD4以及CD8水平均低于对照组(Pa<0.05),CD19水平高于对照组(P<0.05)。25例难治性HSP患儿加用免疫抑制剂治疗后明显好转。结论难治性HSP临床表现复杂,病程长、易反复,大部分为混合型HSP,消化道症状表现严重,肾脏受损程度明显,细胞免疫功能紊乱,单纯激素治疗效果差,需加用免疫抑制剂,积极治疗可减少复发。Objective To explore the clinical feature of refractory Henoch - Schonlein purpura（HSP） and improve the knowledge of the disease. Methods Retrospective method was used to analyze the clinical and laboratory data of 25 children with refractory HSP,and sum up the onset feature,clinical manifestation,treatment and prognosis. SPSS 12.0 software was used to analyze the data. Results Twenty - five children had various degree of digestive symptoms, 17 children （68%） were 4 - 8 years old . The refractory HSP children had a longer abdominal painful time than controls （ P 〈 0.01 ）, 16 children （ 64% ） with refractory gastrointestinal hemorrhage ,2 children combined intussusception, 4 children were misdiagnosised as acute appendicitis. The percentages of renal injury （44%） were higher in 25 cases with refractory HSP than controls（8% ）（P 〈0.01 ）,The quantitation of 24 h urine protein and urine microprotein which bad significant discrepancy compared with controls（ Pa 〈 0.01 ）. The levels of lymphocyte subtypes including CD3, CD4, CD8 were lower in 25 cases with refractory HSP than those in controls（ Pa 〈 0.05 ）, CD19 was higher than that in controls（ P 〈 0.05 ）. All children were improved when combined with immunosuppressor. Conclusions The clinical features of refractory HSP are complicated. It has a long and recurrent course,most children have mixed type HSP and show severe gastrointestinal symptoms and renal injury . Cell - mediated immunity function disturburanee. The treatment of cortical hor, mone has little effect,which need combined with immunosuppressor, positive cure should be helpful for reducing relapse.

关 键 词：过敏性紫癜 难治性 临床表现 儿童 

分 类 号：R725.5[医药卫生—儿科]