儿童紫癜性肾炎中医证型与临床预后回顾性分析  

Retrospective Analysis of Chinese Medicine Syndrome and Clinical Prognosis of Purpura Nephritis in Children

作　　者：丁珂珂 王彩云 宋纯东[1,2] 王耀献[4] 张霞[1,2] 丁樱[1,2] 任献青[1,2] 翟文生[1,2] DING Keke;WANG Caiyun;SONG Chundong;WANG Yaoxian;ZHANG Xia;DING Ying;REN Xianqing;ZHAI Wensheng(The First Affiliated Hospital to Henan University of Chinese Medicine,Henan Zhengzhou China 450000;College of Pediatrics,Henan University of Chinese Medicine,Zhengzhou Henan China 450046;Xinmi Hospital of Chinese Medicine,Xinmi Henan China 452370;Henan University of Chinese Medicine,Henan Zhengzhou China 450046)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000 [2]河南中医药大学儿科医学院,河南郑州450046 [3]新密市中医院,河南新密452370 [4]河南中医药大学,河南郑州450046

出　　处：《中医学报》2024年第10期2233-2238,共6页Acta Chinese Medicine

基　　金：国家自然科学基金项目(82074493)。

摘　　要：目的:通过回顾分析紫癜性肾炎(Henoch-Schonlein purpura nephritis,HSPN)住院患儿病历,探讨其中医证型分布与临床预后相关性。方法:整理2017年1月至2019年12月在河南中医药大学第一附属医院儿科肾病住院行肾活检诊断为HSPN并符合纳入标准患儿的临床资料,并部分随访,分析临床预后与中医证型的相关性。结果:(1)本研究共纳入HSPN患儿341例,男女比例1.27:1,发病年龄9(7,11)岁,中医证型分布为:血热夹瘀证>气阴两虚夹瘀证>阴虚夹瘀证>风热夹瘀证,各证型分布比较,差异有统计学意义(P<0.05)。(2)各证型在性别、发病年龄、发病季节、临床分型方面分布比较,差异无统计学意义(P>0.05)。(3)各证型在紫癜复发次数、腹痛、关节痛方面分布比较,差异无统计学意义(P>0.05),阴虚夹瘀证和气阴两虚夹瘀证水肿的发生率较高(P<0.05)。(4)气阴两虚夹瘀证组24小时尿蛋白定量(24 hour urinary protein quantity,24hUTP)水平高于其余3组,ALB水平低于血热夹瘀证组(P<0.05),尿素氮(urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、血尿酸(serum uric acid,SUA)水平各组间比较,差异无统计学意义(P>0.05)。(5)各组间凝血功能指标比较,差异无统计学意义(P>0.05)。(6)阴虚夹瘀证和气阴两虚夹瘀证组IgG水平低于其余两组(P<0.05),各组IgE、IgA、IgM、C3、C4水平间比较,差异无统计学意义(P>0.05)。(7)本研究共随访224例(65.7%),失访率34.3%,各组间预后差异比较,差异无统计学意义(P>0.05)。结论:HSPN的发病与气候、年龄、性别及小儿体质有关,发病期间以血热夹瘀证和气阴两虚夹瘀证为主;气阴两虚证与水肿的发生、24hUTP、血清白蛋白、IgG水平密切相关;HSPN的临床预后与中医证型无关。Objective:To retrospectively analyze the medical records of hospitalized children with Henoch-Schonlein purpura nephritis(HSPN)and to explore the correlation between the distribution of TCM syndrome types and clinical prognosis.Methods:From January 2017 to December 2019,the clinical data of children diagnosed with HSPN who were diagnosed with HSPN by renal biopsy in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were collected and partially followed up to analyze the correlation with TCM syndrome types.Results:(1)A total of 341 children with HSPN were included in this study,with a male-to-female ratio of 1.27:1 and an age of onset of 9(7,11)years,and the distribution of TCM syndrome types was as follows:blood Heat and stasis syndrome>Qi and Yin deficiency and stasis syndrome>Yin deficiency and stasis syndrome>Wind Heat and stasis syndrome,and the distribution of each syndrome type was statistically significant(P<0.05).(2)There was no significant difference in the distribution of each syndrome type in terms of gender,age of onset,onset season and clinical classification(P>0.05).(3)There was no significant difference in the number of recurrences of purpura,abdominal pain and arthralgia among the syndrome types(P>0.05),and the incidence of edema was significantly higher in Yin deficiency as well as Qi and Yin deficiency and stasis pattern(P<0.05).(4)The level of 24-hour urinary protein quantity(24h-UTP)in the group was significantly higher than that in the other three groups,while the level of ALB was significantly lower than that in the group with blood fever and stasis pattern(P<0.05),and the levels of urea nitrogen(BUN),serum creatinine(Scr)and serum uric acid(SUA)were compared among the groups.There was no significant difference(P>0.05).(5)There was no significant difference in coagulation function between groups(P>0.05).(6)The levels of IgG in the Yin and Qi deficiency as well as Yin deficiency and stasis syndrome groups were lower than those in the other two groups(P<0.05),an

关 键 词：儿童紫癜性肾炎 中医证型 临床预后 

分 类 号：R277.592.34[医药卫生—中医学]