中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2011年
6期
500-503
,共4页
洪建东%王明嶂%郑天文%傅清流%苏志强
洪建東%王明嶂%鄭天文%傅清流%囌誌彊
홍건동%왕명장%정천문%부청류%소지강
过敏性紫癜%肾损害%早期诊断%干预%儿童
過敏性紫癜%腎損害%早期診斷%榦預%兒童
과민성자전%신손해%조기진단%간예%인동
Henoch-Schonlein purpura%Renal damage%Early diagnosis%Intervention%Children
目的 探讨过敏性紫癜( Henoch-Schonlein purpura,HSP)患儿早期肾损害诊断的实验室指标及早期干预的临床疗效.方法 对143例多次尿常规检查正常的HSP患儿进一步检测尿微量蛋白[免疫球蛋白G(IgG)、微量白蛋白(MA)、转铁蛋白(TRF)、a1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)]以及尿酶[N-乙酰-β-D氨基葡萄糖苷酶(NAG),y-谷氨酰转肽酶(y-GT)]的含量.采用对比研究方法,将131例检查异常的HSP患儿随机分成两组(对照组65例、干预组66例).两组均给予甲氰咪胍、氯雷他定、钙剂等综合治疗,干预组66例在综合治疗的基础上加用小剂量肝素微量泵持续定时静脉滴注及甘利欣口服治疗,对照组65例未给予其他治疗.结果 143例尿常规检查正常的HSP患儿中尿微量蛋白和尿酶异常131例(91.61％),干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较治j前降低,差异有统计学意义(P＜0.01).对照组治疗2个月仅尿β2-MG、NAG、y-GT 3项指标降低,差异有统计学意义(P＜0.01),治疗4个月尿微量蛋白、尿酶各项指标均较治疗前降低,差异有统计学意义(P＜0.01).干预组治疗2个月、4个月尿微量蛋白、尿酶各项指标均较对照组低,差异有统计学意义(P ＜0.05或P＜0.01).尿IgG、MA、TRF 、NAG恢复较快,干预组治疗4个月时已基本接近正常,而尿α1-MG、β2-MG、γ-GT恢复较慢,干预组治疗4个月时仍有轻重不一的异常.两组治疗4个月时,对照组尿常规异常率高于干预组(36.92％ vs 6.10％),差异有统计学意义(P＜0.05).结论 尿微量蛋白及尿酶7项指标的联合检测是早期诊断HSP肾损害的良好指标.应用肝素钠、甘利欣对其进行早期干预,能有效预防肾损害,延缓疾病进展.对HSP肾损害须强调早期诊断及早期干预.
目的 探討過敏性紫癜( Henoch-Schonlein purpura,HSP)患兒早期腎損害診斷的實驗室指標及早期榦預的臨床療效.方法 對143例多次尿常規檢查正常的HSP患兒進一步檢測尿微量蛋白[免疫毬蛋白G(IgG)、微量白蛋白(MA)、轉鐵蛋白(TRF)、a1-微毬蛋白(α1-MG)、β2-微毬蛋白(β2-MG)]以及尿酶[N-乙酰-β-D氨基葡萄糖苷酶(NAG),y-穀氨酰轉肽酶(y-GT)]的含量.採用對比研究方法,將131例檢查異常的HSP患兒隨機分成兩組(對照組65例、榦預組66例).兩組均給予甲氰咪胍、氯雷他定、鈣劑等綜閤治療,榦預組66例在綜閤治療的基礎上加用小劑量肝素微量泵持續定時靜脈滴註及甘利訢口服治療,對照組65例未給予其他治療.結果 143例尿常規檢查正常的HSP患兒中尿微量蛋白和尿酶異常131例(91.61％),榦預組治療2箇月、4箇月尿微量蛋白、尿酶各項指標均較治j前降低,差異有統計學意義(P＜0.01).對照組治療2箇月僅尿β2-MG、NAG、y-GT 3項指標降低,差異有統計學意義(P＜0.01),治療4箇月尿微量蛋白、尿酶各項指標均較治療前降低,差異有統計學意義(P＜0.01).榦預組治療2箇月、4箇月尿微量蛋白、尿酶各項指標均較對照組低,差異有統計學意義(P ＜0.05或P＜0.01).尿IgG、MA、TRF 、NAG恢複較快,榦預組治療4箇月時已基本接近正常,而尿α1-MG、β2-MG、γ-GT恢複較慢,榦預組治療4箇月時仍有輕重不一的異常.兩組治療4箇月時,對照組尿常規異常率高于榦預組(36.92％ vs 6.10％),差異有統計學意義(P＜0.05).結論 尿微量蛋白及尿酶7項指標的聯閤檢測是早期診斷HSP腎損害的良好指標.應用肝素鈉、甘利訢對其進行早期榦預,能有效預防腎損害,延緩疾病進展.對HSP腎損害鬚彊調早期診斷及早期榦預.
목적 탐토과민성자전( Henoch-Schonlein purpura,HSP)환인조기신손해진단적실험실지표급조기간예적림상료효.방법 대143례다차뇨상규검사정상적HSP환인진일보검측뇨미량단백[면역구단백G(IgG)、미량백단백(MA)、전철단백(TRF)、a1-미구단백(α1-MG)、β2-미구단백(β2-MG)]이급뇨매[N-을선-β-D안기포도당감매(NAG),y-곡안선전태매(y-GT)]적함량.채용대비연구방법,장131례검사이상적HSP환인수궤분성량조(대조조65례、간예조66례).량조균급여갑청미고、록뢰타정、개제등종합치료,간예조66례재종합치료적기출상가용소제량간소미량빙지속정시정맥적주급감리흔구복치료,대조조65례미급여기타치료.결과 143례뇨상규검사정상적HSP환인중뇨미량단백화뇨매이상131례(91.61％),간예조치료2개월、4개월뇨미량단백、뇨매각항지표균교치j전강저,차이유통계학의의(P＜0.01).대조조치료2개월부뇨β2-MG、NAG、y-GT 3항지표강저,차이유통계학의의(P＜0.01),치료4개월뇨미량단백、뇨매각항지표균교치료전강저,차이유통계학의의(P＜0.01).간예조치료2개월、4개월뇨미량단백、뇨매각항지표균교대조조저,차이유통계학의의(P ＜0.05혹P＜0.01).뇨IgG、MA、TRF 、NAG회복교쾌,간예조치료4개월시이기본접근정상,이뇨α1-MG、β2-MG、γ-GT회복교만,간예조치료4개월시잉유경중불일적이상.량조치료4개월시,대조조뇨상규이상솔고우간예조(36.92％ vs 6.10％),차이유통계학의의(P＜0.05).결론 뇨미량단백급뇨매7항지표적연합검측시조기진단HSP신손해적량호지표.응용간소납、감리흔대기진행조기간예,능유효예방신손해,연완질병진전.대HSP신손해수강조조기진단급조기간예.
Objective To investigate the efficacy of laboratory tests in the renal damage early diagnosis of children with Henoch-Schoalein purpura (HSP) and clinical effect of early intervention.Methods For the 143 HSP patients with normal repeated urine routine test findings,renal function biomarkers including urinary proteins ( immunoglobulin G (IgG),micro-albumin ( MA ),transferrin (TRF),a1 -microglobulin ( α1 -MG),β2-Microglobulin (β2-MG) ) and urinary enzymes ( N-acetyl-beta-D-glucosaminidase ( NAG ),γ-glutamyltransferase (y-GT) ) were detected to investigate the details of renal function changes.One hundred and thirty-one HSP patients,who had abnormal laboratory test findings of renal function biomarkers mentioned above,were randomly divided into control group ( n =65 ) and intervention group ( n =66 ),and both groups received comprehensive treatment including cimetidine,loratadine and calcium agents.However,66 patients in intervention group received low-dose heparin via micropump-based continuous intravenous infusion and regular oral diammonium glycyrrhizinate treatment.Sixty-five patients were enrolled in control group,without further treatment.Results Among the 143 patients with normal urine routine examination,131 cases (91.61％ ) had abnormal findings of renal function biomarkers.After therapy either for 2 months or 4 months,urine protein and urine enzymes were lower than before treatment,and the difference was significant (P ＜ 0.01 ).In the control group only β2-MG,NAG,γ-GT3 indexes significantly lowered at the end of 2 months ( P ＜0.01 ),and all parameters were significantly decreased at the end of 4 months ( P ＜0.01 ).Furthermore,Intervention group had lower levels of renal function biomarkers at the end of 2 months or 4 months,as compared with the control group,showing significant difference ( P ＜0.05 or P ＜0.01 ).Urinary IgG,MA,TRF,NAG recovered rapidly in the intervention group after 4 months and almost returned to the normal,but urinary α1-MG,β2-MG,γ-GT recovered slowly and still remained abnormal after 4 months due to the varying severity.After treatment for 4 months,the rate of urine testing abnormalities was higher in the control group than in the intervention group (36.92％ vs 6.10％ ),and the difference was significant (P ＜0.05).Conclusion Combined detection of renal function biomarkers is helpful for early diagnosis of renal damage in HSP patients.Early intervention with heparin and diammonium glycyrrhizinate can prevent kidney damage,delay disease progress.Early diagnosis and early intervention should be emphasized for the treatment strategy of the renal damage of children with HSP.
