过敏性紫癜患儿早期肾损害的实验室检查及干预  

Laboratory tests and intervention of early renal damage in children with Henoch-Schonlein purpura

作　　者：洪建东[1] 王明峰[2] 郑天文[1] 傅清流[1] 苏志强[1] 

机构地区：[1]福建省泉州市儿童医院,362000 [2]福建省安溪县医院,362400

出　　处：《中国小儿急救医学》2011年第6期500-503,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨过敏性紫癜（Henoch-Schonlein purpura，HSP）患儿早期肾损害诊断的实验室指标及早期干预的临床疗效。方法对143例多次尿常规检查正常的HSP患儿进一步检测尿微量蛋白[免疫球蛋白G（IgG）、微量白蛋白（MA）、转铁蛋白（TRF）、α1-微球蛋白（α1-MG）、β2-微球蛋白（β2-MG）]以及尿酶[N-乙酰-β-D氨基葡萄糖苷酶（NAG），γ-谷氨酰转肽酶（γ-GT）]的含量。采用对比研究方法，将131例检查异常的HSP患儿随机分成两组（对照组65例、干预组66例）。两组均给予甲氰咪胍、氯雷他定、钙剂等综合治疗，干预组66例在综合治疗的基础上加用小剂量肝素微量泵持续定时静脉滴注及甘利欣口服治疗，对照组65例未给予其他治疗。结果143例尿常规检查正常的HSP患儿中尿微量蛋白和尿酶异常131例（91．61％），干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较治疗前降低，差异有统计学意义（P〈0．01）。对照组治疗2个月仅尿132-MG、NAG、γ-GT3项指标降低，差异有统计学意义（P〈0．01），治疗4个月尿微量蛋白、尿酶各项指标均较治疗前降低，差异有统计学意义（P〈0．01）。干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较对照组低，差异有统计学意义（P〈0．05或P〈0．01）。尿IgG、MA、TRF、NAG恢复较快，干预组治疗4个月时已基本接近正常，而尿α1-MG、B2-MG、γ-GT恢复较慢，干预组治疗4个月时仍有轻重不一的异常。两组治疗4个月时，对照组尿常规异常率高于干预组（36．92％VS6．10％），差异有统计学意义（P〈0．05）。结论尿微量蛋白及尿酶7项指标的联合检测是早期诊断HSP肾损害的良好指标。应用肝素钠、甘利欣对其进行早期干预，能有效预防肾损害，延缓疾病进展。对HSP肾损害须强调早期诊断及早期干预。Objeαive To investigate the efficacy of laboratory tests in the renal damage early diagnosis of children with Henoch-Schonlein purpura （HSP） and clinical effeα of early intervention. Methods For the 143 HSP patients with normal repeated urine routine test findings ,renal funαion biomarkers including urinary proteins （ immunoglobulin G （ IgG ）, micro-albumin （ MA）, transferrin （ TRF）, α -microglobulin （ α-MG）, 132-Microglobulin （β2-MG） ） and urinary enzymes （ N-acetyl-beta-D-glucosaminidase （ NAG）, -γ-glutamyltransferase （γ-GT） ） were deteαed to investigate the details of renal funαion changes. One hundred and thirty-one HSP patients, who had abnormal laboratory test findings of renal funαion biomarkers mentioned above, were randomly divided into control group （n = 65 ） and intervention group （n = 66 ）, and both groups received comprehensive treatment including cimetidine,loratadine and calcium agents. However, 66 patients in intervention group received low-dose heparin via micropump-based continuous intravenous infusion and regular oral diammonium glycyrrhizinate treatment. Sixty-five patients were enrolled in control group,without further treatment. Results Among the 143 patients with normal urine routine examination, 131 cases （91.61%） had abnormal findings of renal funαion biomarkers. After therapy either for 2 months or 4 months, urine protein and urine enzymes were lower than before treatment, and the difference was significant （P 〈 0. 01 ）. In the control group only β2-MG, NAG,γ-GT3 indexes significantly lowered at the end of 2 months （ P 〈 0. 01 ）, and all parameters were significantly decreased at the end of 4 months （ P 〈 0. 01 ）. Furthermore,Intervention group had lower levels of renal funαion biomarkers at the end of 2 months or 4 months, as compared with the control group, showing significant difference （ P 〈 0.05 or P 〈 0. 01 ）. Urinary IgG,MA, TRF, NAG recovered rapidly in the intervention group after 4 mont

关 键 词：过敏性紫癜 肾损害 早期诊断 干预 儿童 

分 类 号：R725.5[医药卫生—儿科]