229例儿童IgA血管炎腹部受累诊治分析  

The diagnosis and treatment analysis of abdominal involvement in 229 children with IgA vasculitis

作　　者：傅桐 赵成广[1] 侯玲[1] 王秀丽[1] 杜悦[1] Fu Tong;Zhao Chengguang;Hou Ling;Wang Xiuli;Du Yue(Department of Pediatric Nephrology,Rheumatism and Immunology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿肾脏风湿免疫内科,沈阳110004

出　　处：《中国小儿急救医学》2021年第9期793-796,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的总结229例儿童IgA血管炎腹部受累的诊治过程,为临床治疗提供参考。方法对2018年1月1日至2019年12月31日于中国医科大学附属盛京医院小儿肾脏风湿免疫内科病房229例IgA血管炎伴腹部受累患儿的临床资料行回顾性分析,根据疼痛数字评价量表分为轻度组(161例)、中度组(52例)、重度组(16例)3组,比较不同腹部受累程度患儿各指标变化。结果患儿腹痛程度越重,住院时间越长(P<0.001),血便出现率越高(P<0.001)。随腹痛加重,肠壁水肿占比增大,其中重度组最高(P<0.001)。重度组肾脏受累比例较非重度组明显增大(P<0.001)。3组中肠壁水肿伴白蛋白降低患儿共20例,予输注白蛋白后再行静脉激素治疗,均无肠道并发症出现。与轻、中度组相比,重度组患儿血白细胞计数升高、白蛋白降低,差异有统计学意义(P<0.05),而3组间血红蛋白、血淀粉酶、血脂肪酶差异无统计学意义。3组C-反应蛋白值均高于正常值,但差异无统计学意义。重度组患儿白细胞介素(IL)-6较其他两组升高(P<0.05),而IL-2、IL-4、IL-10、IL-17、肿瘤坏死因子差异无统计学意义。治疗上,40例应用丙种球蛋白、4例行血液灌流治疗。3组患儿糖皮质激素静脉使用平均时长与腹痛程度相关,其中重度组最长(16.00±6.91)d,轻度组最短(6.71±3.75)d。结论IgA血管炎严重腹痛患儿部分炎症指标升高、白蛋白降低,需要及时行影像学检查评估肠壁水肿情况。如患儿白蛋白降低、肠壁水肿明显,建议输注白蛋白后予激素治疗,防止肠道穿孔等严重并发症出现。对于重症腹痛患儿,在激素治疗的基础上,必要时可采取丙种球蛋白、血液灌流治疗快速清除异常免疫物质以减缓病症。Objective To summarize the diagnosis and treatment process of abdominal involvement in 229 children with IgA vasculitis and to provide reference for clinic treatment.Methods A total of 229 pediatric patients,diagnosed as IgA vasculitis with abdominal involvement admitted to the Department of Pediatric Nephrology of Shengjing Hospital,China Medical University from January 1st 2018 to December 31st 2019,were retrospectively analyzed in the study and were divided into three groups according to Numerical Rating Scale to compare indexes in different degrees of abdominal pain.Results The duration of hospitalization was related with degree of abdominal pain,as the more severe the abdominal pain was,the longer the hospitalization time was(P<0.001).The incidence of bloody stool were also proportionate to the degree of abdominal pain(P<0.001).With the aggravation of abdominal pain,the proportion of intestinal wall edema increased,as the highest proportion was severe group(P<0.001).The proportion of renal involvement in severe group was significantly higher than that in non-severe group(P<0.001).Twenty cases of intestinal wall edema with decreasing of albumin were treated by intravenous hormone therapy after albumin infusion as the results of no intestinal complications occurred.Compared with the mild and moderate groups,the white blood cells of the severe group were higher(P<0.001)and the albumin was lower(P<0.05).It was no significant difference in hemoglobin,serum amylase and serum lipase among three groups.The mean value of CRP had no difference among three groups and was higher than that of normal.Interleukin(IL)-6 in severe group was higher than that in other two groups(P<0.05),but there was no significant difference in IL-2,IL-4,IL-10,IL-17 and tumor necrosis factor.In terms of treatment,40 cases were treated with immunoglobulin and four cases with hemoperfusion.The average duration of intravenous glucocorticoid application was related to the degree of abdominal pain among three groups.The longest duration was severe

关 键 词：IgA血管炎 腹部受累 儿童 诊疗 

分 类 号：R725.5[医药卫生—儿科]