肺炎链球菌、肺炎支原体、柯萨奇病毒及EB病毒感染与儿童过敏性紫癜肾炎的相关性研究  

Study on the correlation between streptococcus pneumoniae,mycoplasma pneumoniae,coxsackie virus and epstein-barr virus infections and childhood henoch-schonlein purpura nephritis

作　　者：王彩芳[1] 么鑫 蔡花 张菂[1] 黄翠影 梁晓亮[2] 陈瑞珊 海冬[1] WANG Cai-fang;MO Xin;CAI Hua(Department of Pediatrics,Kailuan General Hospital,Tangshan Hebei 063000,China.)

机构地区：[1]开滦总医院儿科,河北唐山063000 [2]开滦精神卫生中心,河北唐山063001

出　　处：《临床和实验医学杂志》2022年第19期2099-2103,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省卫健委重点科技研究计划项目(编号:20191335)。

摘　　要：目的研究肺炎链球菌(SP)、肺炎支原体(MP)、柯萨奇病毒(CBV)及EB病毒(EBV)感染与儿童过敏性紫癜肾炎(HSPN)的相关性。方法回顾性收集2016年6月至2021年12月开滦总医院收治301例过敏性紫癜(HSP)患儿的临床资料,按是否发生HSPN分为HSPN组(n=120)和非HSPN组(n=181)。统计两组性别、年龄、HSP分型、皮疹持续时间、相关实验室指标以及SP、MP、CBV、EBV感染等资料数据,采用多因素Logistic回归分析SP、MP、CBV及EBV感染与儿童HSPN的相关性。结果HSPN组患儿肾型及混合型HSP占比、皮疹持续时间、C反应蛋白、血尿素氮、血肌酐、尿微量白蛋白、24 h尿蛋白、血小板计数、D-二聚体、肌酸激酶同工酶、乳酸脱氢酶、免疫球蛋白(Ig)A、IgG及补体4水平和SP、MP、CBV及EBV感染率显著高于非HSPN组,Cys-C及补体3水平显著低于非HSPN组,差异均有统计意义(P<0.05)。Logistic回归分析结果显示,肾型HSP、混合型HSP、皮疹持续时间≥30 d、IgA升高、IgG升高、SP感染、MP感染、CBV感染及EBV感染是儿童HSPN的高危因素(OR=1.217,1.318,3.001,1.744,1.807,1.051,2.803,1.347,1.331;95%CI:0.925~1.379,0.891~1.434,1.281~5.653,1.010~2.640,1.012~2.631,1.651~2.633,1.013~2.097,1.095~1.748,1.144~1.835)。结论SP、MP、CBV及EBV感染与儿童HSPN的有关,尤其对合并肾型及混合型HSP、皮疹持续时间超过1个月、IgA及IgG升高的患儿要加以重视,提前做好防范HSPN准备。Objective To study the association of Streptococcus pneumoniae( SP),Mycoplasma pneumoniae( MP),Coxsackie B virus( CBV) and Epstein-Barr virus( EBV) infections with Henoch-Schonlein purpura nephritis( HSPN) in children. Methods The clinical data of 301 children with Henoch-Schonlein purpura( HSP) admitted to Kailuan General Hospital from June 2016 to December 2021 were collected and divided into HSPN group( n = 120) and non-HSPN group( n = 181) according to whether HSPN occurred or not. The data of gender,age,HSP classification,rash duration,relevant laboratory indexes and SP,MP,CBV and EBV infection in the two groups were counted. The correlation between SP,MP,CBV and EBV infection and HSPN in children was analyzed by multivariate logistic regression. Results The proportion of renal-type and mixed-type HSP,duration of rash,C reactive protein,blood urea nitrogen,serum creatinine,urine microalbumin,24 h urine protein,platelet count,D-dimer,creatine kinase-MB,lactate dehydrogenase,Ig A,Ig G and C4 levels,SP,MP,CBV and EBV infection rates in HSPN group were significantly higher than those in the non-HSPN group( P < 0. 05),and the levels of Cys-C and C3 were significantly lower than those in the non-HSPN group( P < 0. 001). Logistic regression analysis showed that renal HSP,mixed HSP,rash duration≥30 d,immunoglobulin( Ig) A increased,Ig G increased,SP infection,MP infection,CBV infection and EBV infection were high risk factors for HSPN in children( OR = 1. 217,1. 318,3. 001,1. 744,1. 807,1. 051,2. 803,1. 347,1. 331;95% CI : 0. 925-1. 379,0. 891-1. 434,1. 281-5. 653,1. 01-2. 640,1. 012-2. 631,1. 651-2. 633,1. 013-2. 097,1. 09-1. 748,1. 144-1. 835). Conclusion SP,MP,CBV and EBV infection are related to HSPN in children. In particular,children with renal and mixed HSP,rash lasting more than 1 month,and elevated Ig A and Ig G should be paid attention to and prepared to prevent HSPN in advance.

关 键 词：过敏性紫癜肾炎 肺炎链球菌 肺炎支原体 柯萨奇病毒 EB病毒 

分 类 号：R726.9[医药卫生—儿科]