儿童腹型过敏性紫癜100例临床分析-儿科学专业论文.docxVIP

目 录 中文摘要 ·············································································1 英文摘要 ·············································································4 研究论文 儿童腹型过敏性紫癜 100 例临床分析 前言 ·············································································8 材料与方法 ····································································9 结果 ·············································································11 附表 ·············································································13 讨论 ·············································································15 结论 ·············································································20 参考文献 ·······································································21 综述 儿童腹型过敏性紫癜的研究进展 ········································23 致谢 ···················································································33 个人简历 ·············································································34 儿童腹型过敏性紫癜 100 例临床分析 摘 要 目的： 过敏性紫癜（Henoch-Schonlein purpura）是由免疫复合物介导的全身 毛细血管的变态反应性及出血性疾病，好发于学龄前期和学龄期儿童。腹 型过敏性紫癜以侵犯内脏毛细血管及细小动脉为主，是过敏性紫癜的一种 类型。腹型过敏性紫癜临床表现为腹部绞痛、呕吐和消化道出血，合并消 化道出血的约占 18％～52％。目前关于腹型过敏性紫癜的诊断尚没有明 确的辅助检查金标准。临床工作中，部分腹型过敏性紫癜患儿是以胃肠道 症状首先起病，早期看不到典型的皮肤紫癜，给临床诊断带来极大的困难， 导致延误诊治，不但使消化道出血等并发症的风险增加，也使治疗费用及 病死率明显增加。据报道，儿童腹型过敏性紫癜的超声表现有一定的特异 性,不但能早期发现肠管病变，而且没有放射性辐射、重复性好。因此， 本文通过对 100 例儿童腹型过敏性紫癜患儿的临床、腹部超声及化验室检 查指标进行综合分析，旨在为腹型过敏性紫癜患儿的早期诊断、病情判断、 评估预后、危险预测和药物治疗提供参考依据。 方法： 1 研究对象：本课题病例组共入组 100 例，男 60 例，女 40 例，年龄 3-13 岁(平均 7.7±6.5 岁)。均为 2014.11-2015.10 期间在河北省儿童医院肾 脏免疫科在期间诊断为腹型过敏性紫癜的住院患儿，按有无消化道出血分 为消化道出血组与无出血组，均为初次发病，且处于急性期（＜7 天）。 腹型过敏性紫癜的诊断符合第八版《诸福棠实用儿科学》的过敏性紫癜诊 断标准，并以腹痛、便血及呕吐等消化道症状为主要临床表现。将临床表 现为呕血、排黑色柏油样便或者鲜红色血便，或者化验检查便潜血实验阳 性者为合并消化道出血。所有病例已除外病情反复，病程大于 7 天以及合 并严重感染、幽门螺杆菌感染、肝肾心脑疾病、基础胃肠道疾病、其他类 型的风湿免疫性疾病、4 周内应用过激素或免疫抑制剂治疗的患儿。 2 检测指标及实验方法：所有患儿均于入院 2 天内做血尿便常规、便 潜血、C 反应蛋白、血沉、血 IgA 水平、肝肾功能、心电图及肠道超声检 查。肠道超声主要观察肠管壁厚度、腹腔积液、肠系膜淋巴结情况。分析 各项指标在有消化道出血组与无消化道出血组之间的差异。 3 统计学方法：对数据进行统计学分析采用 SP