CAJ | 학술논문

目的：探讨儿童过敏性紫癜（HSP）合并心脏损害的临床特点及危险因素。方法对南京市儿童医院2011年11月至2012年12月收治的707例住院 HSP 患儿的临床及实验室资料进行回顾性分析，同时记录 HSP 合并心脏损害可能的相关危险因素，包括性别、年龄、发病前存在诱因、腹痛、关节痛、肾损害情况、血电解质、抗“O”、红细胞沉降率、类风湿因子、补体水平等。采用 Pearson χ2检验及二元 Logistic 回归分析探讨 HSP患儿合并心脏损害的危险因素。结果 HSP 合并心脏损害的有192例，占总病例27.2％，其中男115例，女77例，男女比例为1.00：0.67；年龄11个月~15岁4个月（中位年龄6岁5个月），﹤3岁6例（3.1％），≥3~7岁103例（53.7％），≥7~14岁82例（42.7％），≥14岁1例（0.5％），发病年龄多在学龄前期及学龄期。192例患儿中有190例存在心电图异常，主要表现为 Q-T 间期延长、ST-T 改变及窦性心动过缓；24例存在1项或多项心肌酶异常；35例患儿行超声心动图检查，均无心内结构异常改变；患儿均未述明显胸闷、心慌或心前区不适等症状。χ2检验显示：患儿性别、发病前存在诱因、临床表现为混合型 HSP、伴低补体血症与 HSP 合并心脏损害有关（P ﹤0.05）；二元 Logistic 回归分析显示，男性患儿（X1）的比值比（OR）值为0.654（95％ CI 0.462~0.926，P ﹤0.05），有无发病诱因（X2）的 OR 值为2.63（95％ CI 1.838~3.765，P ﹤0.001），临床表现为混合型HSP（X3）的 OR 值为2.452（95％ CI 1.301~4.621，P ﹤0.01）。结论 HSP 合并心脏损害的特征主要为心电图和/或心肌酶谱异常。对男性患儿、发病前存在呼吸道感染等诱因、临床表现为混合型 HSP、有低补体血症者应予高度重视，尽早行心电图、心肌酶等相关检查，并早期进行诊治，避免重症病例的发生。目的：探討兒童過敏性紫癜（HSP）閤併心髒損害的臨床特點及危險因素。方法對南京市兒童醫院2011年11月至2012年12月收治的707例住院 HSP 患兒的臨床及實驗室資料進行迴顧性分析，同時記錄 HSP 閤併心髒損害可能的相關危險因素，包括性彆、年齡、髮病前存在誘因、腹痛、關節痛、腎損害情況、血電解質、抗“O”、紅細胞沉降率、類風濕因子、補體水平等。採用 Pearson χ2檢驗及二元 Logistic 迴歸分析探討 HSP患兒閤併心髒損害的危險因素。結果 HSP 閤併心髒損害的有192例，佔總病例27.2％，其中男115例，女77例，男女比例為1.00：0.67；年齡11箇月~15歲4箇月（中位年齡6歲5箇月），﹤3歲6例（3.1％），≥3~7歲103例（53.7％），≥7~14歲82例（42.7％），≥14歲1例（0.5％），髮病年齡多在學齡前期及學齡期。192例患兒中有190例存在心電圖異常，主要錶現為 Q-T 間期延長、ST-T 改變及竇性心動過緩；24例存在1項或多項心肌酶異常；35例患兒行超聲心動圖檢查，均無心內結構異常改變；患兒均未述明顯胸悶、心慌或心前區不適等癥狀。χ2檢驗顯示：患兒性彆、髮病前存在誘因、臨床錶現為混閤型 HSP、伴低補體血癥與 HSP 閤併心髒損害有關（P ﹤0.05）；二元 Logistic 迴歸分析顯示，男性患兒（X1）的比值比（OR）值為0.654（95％ CI 0.462~0.926，P ﹤0.05），有無髮病誘因（X2）的 OR 值為2.63（95％ CI 1.838~3.765，P ﹤0.001），臨床錶現為混閤型HSP（X3）的 OR 值為2.452（95％ CI 1.301~4.621，P ﹤0.01）。結論 HSP 閤併心髒損害的特徵主要為心電圖和/或心肌酶譜異常。對男性患兒、髮病前存在呼吸道感染等誘因、臨床錶現為混閤型 HSP、有低補體血癥者應予高度重視，儘早行心電圖、心肌酶等相關檢查，併早期進行診治，避免重癥病例的髮生。
목적：탐토인동과민성자전（HSP）합병심장손해적림상특점급위험인소。방법대남경시인동의원2011년11월지2012년12월수치적707례주원 HSP 환인적림상급실험실자료진행회고성분석，동시기록 HSP 합병심장손해가능적상관위험인소，포괄성별、년령、발병전존재유인、복통、관절통、신손해정황、혈전해질、항“O”、홍세포침강솔、류풍습인자、보체수평등。채용 Pearson χ2검험급이원 Logistic 회귀분석탐토 HSP환인합병심장손해적위험인소。결과 HSP 합병심장손해적유192례，점총병례27.2％，기중남115례，녀77례，남녀비례위1.00：0.67；년령11개월~15세4개월（중위년령6세5개월），﹤3세6례（3.1％），≥3~7세103례（53.7％），≥7~14세82례（42.7％），≥14세1례（0.5％），발병년령다재학령전기급학령기。192례환인중유190례존재심전도이상，주요표현위 Q-T 간기연장、ST-T 개변급두성심동과완；24례존재1항혹다항심기매이상；35례환인행초성심동도검사，균무심내결구이상개변；환인균미술명현흉민、심황혹심전구불괄등증상。χ2검험현시：환인성별、발병전존재유인、림상표현위혼합형 HSP、반저보체혈증여 HSP 합병심장손해유관（P ﹤0.05）；이원 Logistic 회귀분석현시，남성환인（X1）적비치비（OR）치위0.654（95％ CI 0.462~0.926，P ﹤0.05），유무발병유인（X2）적 OR 치위2.63（95％ CI 1.838~3.765，P ﹤0.001），림상표현위혼합형HSP（X3）적 OR 치위2.452（95％ CI 1.301~4.621，P ﹤0.01）。결론 HSP 합병심장손해적특정주요위심전도화/혹심기매보이상。대남성환인、발병전존재호흡도감염등유인、림상표현위혼합형 HSP、유저보체혈증자응여고도중시，진조행심전도、심기매등상관검사，병조기진행진치，피면중증병례적발생。
Objective To summarize the clinical characteristics and laboratory test results of children with Henoch - Schonlein purpura(HSP),and further to analyze the risk factors for HSP combined with cardiac damage. Methods The clinical and laboratory tests findings from 707 children diagnosed as HSP at Nanjing Children's Hospi-tal were retrospectively analyzed,who were recruited from November 2011 to December 2012. The possible risk factors for HSP with cardiac damage in children were recorded,including gender,age,predisposing causes,gastrointestinal symptoms,joint pain,kidney disorders,serum electrolytes,anti - streptolysin 〝O〝 test,erythrocyte sedimentation rate, and complement level were summarized. Chi - square test and Logistic regression were performed to analyze the risk fac-tors of cardiac damage in children with HSP. Results Among 707 cases,192(27. 2% )patients were combined with car-diac damage,115 male and 77 female,and the proportion of men to women was 1. 00: 0. 67;age ranged from 11 months to 15 years and 4 months(6 years and 5 months for median age),6 patients ﹤ 3 years old occupying 3. 1% ,103 patients≥3 - 7 years old occupying 53. 7% ,82 patients≥7 - 14 years old occupying 42. 7% ,1 patient≥14 years old occupying 0. 5% ,and the age of onset in preschool and school age. Electrocardiogram(ECG)abnormalities were found in 190 patients,the main manifestations including long Q - T interval,ST - T segment falling down and sinus bradycar-dia,and one or more items of abnormal myocardial enzymes existed in 24 cases;echocardiography was performed in 35 cases of children,but no abnormality was detected,no obvious symptoms such as flustered or chest tightness or precor-dial distress. Statistical analysis showed that gender,predisposing causes,mixed HSP,complement level were related to the incidence of cardiac damage in children with HSP(P ﹤ 0. 05). Furthermore binary Logistic regression identified that in male patients,the ratio of X1 vs OR ratio was 0. 654(95% CI 0. 462 - 0. 926,P ﹤ 0. 05),for predisposing causes,the ratio of X2 vs OR ratio was 2. 63(95% CI 1. 838 - 3. 765,P ﹤ 0. 001),for mixed HSP,the ratio of X3 vs OR ratio was 2. 452(95% CI 1. 301 - 4. 621,P ﹤ 0. 01),which were independent factors for cardiac damage in chil-dren with HSP. Conclusions ECG and/ or myocardial enzyme spectrum abnormalities are the main clinical ma-nifestations of cardiac damage in children with HSP. Male patients,predisposing causes of the respiratory tract infec-tion,mixed HSP and hypocomplementemia were high risk factors in the development of cardiac damage,which require special consideration clinically,and earlier ECG and myocardial enzymes examination,early diagnosis and treatment are necessary to avoid the occurrence of severe cases.