中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
22期
10079-10083
,共5页
紫癜,过敏性%儿童%紫癜性肾炎%早期肾损害指标
紫癜,過敏性%兒童%紫癜性腎炎%早期腎損害指標
자전,과민성%인동%자전성신염%조기신손해지표
Purpura,Schoenlein-Henoch%Child%Henoch-Sch?lein purpura nephritis%Early renal injury index
目的：探讨性别、年龄、体液免疫、细胞免疫、尿微量蛋白、24 h尿蛋白作为早期指标在预测过敏性紫癜（HSP）患儿是否合并紫癜性肾炎（HSPN）及肾损伤程度的临床意义。方法搜集2010年1月至2013年6月在我院住院治疗的过敏性紫癜患儿200例，按照是否合并紫癜性肾炎、肾脏病理结果、尿蛋白水平分别进行分组，找出和HSPN密切相关的早期肾损害因素。结果 HSP组与HSPN组比较，血IgG、血IgM、尿微量白蛋白、尿免疫球蛋白G、尿α1微球蛋白、尿β2微球蛋白、尿转铁蛋白、尿N乙酰氨基葡萄糖苷酶差异均有统计学意义（P＜0.05）；性别、CD3、CD4、CD8、CD19、C3、C4、血IgA、尿肌酐差异无统计学意义（P＞0.05）；不同病理分级紫癜性肾炎间，细胞免疫、体液免疫、性别、年龄差异无统计意义（P＞0.05），尿微量白蛋白、尿α1微球蛋白、尿β2微球蛋白、尿免疫球蛋白G、24 h尿蛋白定量差异有统计学意义（P＜0.05）；24 h 尿蛋白定量与肾脏病理分级呈正相关（r＝0.98，P＜0.05）；肾穿刺免疫荧光强度与外周血免疫球蛋白水平无明显相关性（r＝0，P＞0.05），免疫荧光强度与病理结果不完全平行。结论过敏性紫癜是否合并肾损伤，与细胞免疫无明显相关性；如果过敏性紫癜患儿血 IgG 降低，血IgM、尿微量白蛋白、尿α1微球蛋白、尿β2微球蛋白、尿免疫球蛋白G、尿转铁蛋白、尿N乙酰氨基葡萄糖苷酶明显升高，则容易并发紫癜性肾炎；血IgG及24 h尿蛋白水平是HSP患儿是否合并肾损伤较敏感的因素，如果过敏性紫癜患儿血IgG降低、24 h尿蛋白增多，则并发肾损害的可能性大；外周血免疫球蛋白水平与肾脏病理损伤程度不完全一致。
目的：探討性彆、年齡、體液免疫、細胞免疫、尿微量蛋白、24 h尿蛋白作為早期指標在預測過敏性紫癜（HSP）患兒是否閤併紫癜性腎炎（HSPN）及腎損傷程度的臨床意義。方法搜集2010年1月至2013年6月在我院住院治療的過敏性紫癜患兒200例，按照是否閤併紫癜性腎炎、腎髒病理結果、尿蛋白水平分彆進行分組，找齣和HSPN密切相關的早期腎損害因素。結果 HSP組與HSPN組比較，血IgG、血IgM、尿微量白蛋白、尿免疫毬蛋白G、尿α1微毬蛋白、尿β2微毬蛋白、尿轉鐵蛋白、尿N乙酰氨基葡萄糖苷酶差異均有統計學意義（P＜0.05）；性彆、CD3、CD4、CD8、CD19、C3、C4、血IgA、尿肌酐差異無統計學意義（P＞0.05）；不同病理分級紫癜性腎炎間，細胞免疫、體液免疫、性彆、年齡差異無統計意義（P＞0.05），尿微量白蛋白、尿α1微毬蛋白、尿β2微毬蛋白、尿免疫毬蛋白G、24 h尿蛋白定量差異有統計學意義（P＜0.05）；24 h 尿蛋白定量與腎髒病理分級呈正相關（r＝0.98，P＜0.05）；腎穿刺免疫熒光彊度與外週血免疫毬蛋白水平無明顯相關性（r＝0，P＞0.05），免疫熒光彊度與病理結果不完全平行。結論過敏性紫癜是否閤併腎損傷，與細胞免疫無明顯相關性；如果過敏性紫癜患兒血 IgG 降低，血IgM、尿微量白蛋白、尿α1微毬蛋白、尿β2微毬蛋白、尿免疫毬蛋白G、尿轉鐵蛋白、尿N乙酰氨基葡萄糖苷酶明顯升高，則容易併髮紫癜性腎炎；血IgG及24 h尿蛋白水平是HSP患兒是否閤併腎損傷較敏感的因素，如果過敏性紫癜患兒血IgG降低、24 h尿蛋白增多，則併髮腎損害的可能性大；外週血免疫毬蛋白水平與腎髒病理損傷程度不完全一緻。
목적：탐토성별、년령、체액면역、세포면역、뇨미량단백、24 h뇨단백작위조기지표재예측과민성자전（HSP）환인시부합병자전성신염（HSPN）급신손상정도적림상의의。방법수집2010년1월지2013년6월재아원주원치료적과민성자전환인200례，안조시부합병자전성신염、신장병리결과、뇨단백수평분별진행분조，조출화HSPN밀절상관적조기신손해인소。결과 HSP조여HSPN조비교，혈IgG、혈IgM、뇨미량백단백、뇨면역구단백G、뇨α1미구단백、뇨β2미구단백、뇨전철단백、뇨N을선안기포도당감매차이균유통계학의의（P＜0.05）；성별、CD3、CD4、CD8、CD19、C3、C4、혈IgA、뇨기항차이무통계학의의（P＞0.05）；불동병리분급자전성신염간，세포면역、체액면역、성별、년령차이무통계의의（P＞0.05），뇨미량백단백、뇨α1미구단백、뇨β2미구단백、뇨면역구단백G、24 h뇨단백정량차이유통계학의의（P＜0.05）；24 h 뇨단백정량여신장병리분급정정상관（r＝0.98，P＜0.05）；신천자면역형광강도여외주혈면역구단백수평무명현상관성（r＝0，P＞0.05），면역형광강도여병리결과불완전평행。결론과민성자전시부합병신손상，여세포면역무명현상관성；여과과민성자전환인혈 IgG 강저，혈IgM、뇨미량백단백、뇨α1미구단백、뇨β2미구단백、뇨면역구단백G、뇨전철단백、뇨N을선안기포도당감매명현승고，칙용역병발자전성신염；혈IgG급24 h뇨단백수평시HSP환인시부합병신손상교민감적인소，여과과민성자전환인혈IgG강저、24 h뇨단백증다，칙병발신손해적가능성대；외주혈면역구단백수평여신장병리손상정도불완전일치。
Objective To explore the clinical significance of sex, age, humoral immunity, cellular immunity, microalbuminuria, 24 hour urine protein as an early indicator in predicting children with Henoch Schonlein purpura(HSP) wether or no with renal injury and the injury degree. Methods 200 cases with HSP in our hospital from 2010 to 2013 year were collected, then be divided into different groups according to whether with renal injury, and kidney injury degree, and renal biopsy TEM results, and renal biopsy immunofluorescence results.According to the need, using rank sum test, independent samples t test, Logistic regression analysis, variance analysis etc. methods to find out whether there is statistical significance between the groups, and find out the closely related factors to the kidney injury. Results There was no statistical significance in age, gender, CD3, CD4, CD8, CD19, C3, C4, IgA of blood, urine creatinine between HSP group and HSPN group(P>0.05), but had statistical significance in IgG and IgM of blood, urinary albumin, urinary immunoglobulin G, urinaryα1-microglobulin, urinary β2-microglobulin, urinary siderophilin, urinary N acetyl glucosaminidase(P<0.05); Sex, age, humoral immunity, cellular immunity in HSPN of different pathological grading had no statistical difference(P>0.05), urinary albumin, urinaryα1- microglobulin, urinary β2-microglobulin, urinary immunoglobulin G, 24 hour urine protein had statistical difference(P<0.05); 24 hour urinary protein quantitative was positively related with renal pathological grading(r=0, P>0.05); There was no significant correlation between immunofluorescence intensity of renal biopsy and immune globulin level of peripheral blood, the fluorescence intensity was not completely parallel with pathological results. Conclusions Child of HSP whether with renal injury has no relativity with cellular immunity. It is easy to complicated with HSP nephritis if IgG of blood decreased, IgM of blood, urinary albumin, urinary immunoglobulin G, urinary α1-microglobulin, urinary β2-microglobulin, urinary siderophilin, urinary N acetyl glucosaminidase increased; IgG of blood, 24 hours urine protein is the relatively sensitive factors of HSPN, if the IgG of blood obviously decreased and the 24 hours urine protein obviously increased, it is easy to complicate with renal injury.The level of immunoglobulin of peripheral blood is not completely consistent with the degree of renal injury.
