儿童过敏性紫癜消化道出血相关血清标志物分析  

Analysis Of serum markers indicating HenochSch?nlein Purpura related gastrointestinal bleeding of children

作　　者：翟娜娜[1] 谢富佳[1] 李宇宁[2] 凌继祖[2] 刘丽君[2] Zhai Na-na;Xie Fu-jia;Li Yu-ning;Ling Ji-zu;Liu Li-jun(The First Clinical Medical College of Lanzhou University,Lanzhou,Gansu,730000,China;Department of pediatrics,the First Hospital of Lanzhou University,Lanzhou,Gansu,730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院小儿科,甘肃兰州730000

出　　处：《当代医学》2017年第23期4-8,共5页Contemporary Medicine

基　　金：甘肃省卫生行业科研计划项目(GSWSKY-2015-43)

摘　　要：目的分析儿童过敏性紫癜(Henoch-Schonlein purpura,HSP)发生消化道出血的血清学相关危险因素。方法纳入148例HSP患儿,77例腹痛患儿。以白细胞计数(WBC)、中性粒细胞绝对值、淋巴细胞绝对值、中性粒细胞与淋巴细胞的比值(neutrophil to lymphocyte ratio,NLR)、血红蛋白(Hb)、血小板计数(PLT)、平均血小板体积(MPV)、C反应蛋白(C-reactive protein,CRP)及血沉为研究指标,应用SPSS21.0统计分析软件进行数据处理,采用Logistic回归及受试者工作特征曲线(receiver operating characteristic curve,简称ROC曲线)分析血清学标志物与过敏性紫癜消化道出血的相关性。结果 (1)HSP组白细胞计数、中性粒细胞绝对值、血小板、NLR较对照组升高,淋巴细胞绝对值较对照组明显降低,差异有统计学意义(P<0.05);(2)HSP消化道出血组白细胞计数、中性粒细胞绝对值、NLR和CRP较非消化道出血组明显升高,淋巴细胞绝对值明显降低,差异有统计学意义(P<0.05);(3)HSP患儿临床评分与血清标志物白细胞计数(r=0.344,P<0.001)、中性粒细胞绝对计数(r=0.405,P<0.001)、NLR(r=0.364,P<0.001)、血小板计数(r=0.185,P=0.024)及CRP(r=0.258,P=0.002)呈显著正相关;(4)经Logistic逐步回归分析仅CRP及NLR为过敏性紫癜消化道出血的独立相关因素;(5)根据ROC曲线下面积结果,与NLR相比,CRP是过敏性紫癜消化道出血的潜在的更有效的预测指标。结论 CRP>7.25 mg/L及NLR>3.43可作为预测儿童过敏性紫癜消化道出血的简易血清标志物,临床工作中应受到重视。Objective To analyze the serum markers indicating Henoch-Sch?nlein purpura related gastrointestinal(GI)bleeding of children.Methods The study consisted of148HSP patients and77cases of abdominal pain without organic disease.White blood cell count(WBC),absoluteneutrophil count,absolute lymphocyte count,neutrophil to lymphocyte ratio(NLR),hemoglobin(Hb),platelet count(PLT),mean platelet volume(MPV),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)were evaluated.Logistic regression analysis and receiver operating characteristic(ROC)analysis were used to determine the serum markers associated with GI bleeding.Results(1)White blood cell count,absolute neutrophilcount,platelet count,and NLR levels were significantly higher in HSP group compared with the control group,absolute lymphocyte count wassignificantly lower in HSP group(P<0.05).(2)White blood cell count,absolute neutrophil count,NLR,and CRP levels were significantly higher inHSP patients with GI bleeding when compared to patients without GI bleeding,While absolute lymphocyte count was significantly lower in patientswith GI bleeding than the patients without GI bleeding(P<0.05).(3)The total clinical scores of HSP patients were more strongly correlated withWhite blood cell count(r=0.344,P<0.001),absolute neutrophil count(r=0.405,P<0.001),NLR(r=0.364,P<0.001),platelet count(r=0.185,P=0.024),and CRP(r=0.258,P=0.002).(4)CRP and NLR were the only two indicators associated with GI bleeding in HSP in Logistic regression analysis.(5)The area under the ROC curve analysis indicated that CRP could be a more efficient potential predictor of GI bleeding in HSP when comparedto NLR.Conclusion This study suggested that CRP>7.25mg/L jointly with NLR>3.43might predict GI bleeding in HSP better,and should betaken attention in clinical.

关 键 词：过敏性紫癜 消化道出血 血清标志物 NLR CRP 

分 类 号：R725.5[医药卫生—儿科]