儿童过敏性紫癜发病的危险因素研究
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摘要
为了探讨儿童过敏性紫癜发病的危险因素,本研究选取了2015年7月至2017年6月在本院治疗的过敏性紫癜患儿118例作为观察组研究对象,同时选取健康正常儿童120例作为对照组,调查分析两组微生物感染、食物过敏、药物过敏史等资料,同时观察治疗疗效。研究显示,观察组的幽门螺杆菌(Hp)、肺炎支原体、链球菌感染率和螨虫阳性率分别为61.02%、16.10%、10.17%和13.56%,明显高于对照组(p<0.05);观察组对牛奶、鸡蛋、虾过敏的比例分别为9.32%、11.02%和8.47%,明显高于对照组(p<0.05);观察组有药物过敏史、家中饲养猫、狗等动物、家中近3个月装修的比例为22.88%、45.76%和17.80%,明显高于对照组(p<0.05);Logistic回归分析显示,Hp感染是发生过敏性紫癜的危险因素(OR=1.613, p<0.05);Hp感染和无Hp感染患者治疗疗效差异比较无统计学意义(p>0.05)。本研究表明,Hp感染可能是儿童过敏性紫癜发生的影响因素,但Hp感染对治疗疗效无明显影响。
In order to explore the risk factors for the occurrence of allergic purpura in children, in this study, 118 children with allergic purpura treated in our hospital from July 2015 to June 2017 were selected as study objects of the observation group, and 120 healthy children were selected as control group at the same time. The microbiological infection, food allergy, drug allergy history and other data in two groups were investigated and analyzed, and the therapeutic effect was observed at the same time. Studies showed that the infection rates of Helicobacter pylori(Hp), Mycoplasma pneumoniae, streptococcus and mites positive rate in the observation group were 61.02%, 16.10%, 10.17% and 13.56%, respectively, which were significantly higher than those in the control group(p<0.05); The rates of allergy to milk, eggs and shrimp in the observation group were 9.32% 11.02% and 8.47%,respectively, which were significantly higher than those in the control group(p<0.05); In the observation group, the proportion of drug allergies, raising cats, dogs, and other animals at home, home decoration in the past 3 months were 22.88%, 45.76% and 17.80%, which were significantly higher than those in the control group(p<0.05); Logistic regression analysis showed that Hp infection was a risk factor for allergic purpura(OR=1.613, p<0.05); There was no significant difference in the therapeutic effect between patients with Hp infection and non Hp infection(p>0.05).This study indicated that Hp infection might be an influential factor in the occurrence of children's allergic purpura,but Hp infection might have no significant effect on the therapeutic effect.
In order to explore the risk factors for the occurrence of allergic purpura in children, in this study, 118 children with allergic purpura treated in our hospital from July 2015 to June 2017 were selected as study objects of the observation group, and 120 healthy children were selected as control group at the same time. The microbiological infection, food allergy, drug allergy history and other data in two groups were investigated and analyzed, and the therapeutic effect was observed at the same time. Studies showed that the infection rates of Helicobacter pylori(Hp), Mycoplasma pneumoniae, streptococcus and mites positive rate in the observation group were 61.02%, 16.10%, 10.17% and 13.56%, respectively, which were significantly higher than those in the control group(p<0.05); The rates of allergy to milk, eggs and shrimp in the observation group were 9.32% 11.02% and 8.47%,respectively, which were significantly higher than those in the control group(p<0.05); In the observation group, the proportion of drug allergies, raising cats, dogs, and other animals at home, home decoration in the past 3 months were 22.88%, 45.76% and 17.80%, which were significantly higher than those in the control group(p<0.05); Logistic regression analysis showed that Hp infection was a risk factor for allergic purpura(OR=1.613, p<0.05); There was no significant difference in the therapeutic effect between patients with Hp infection and non Hp infection(p>0.05).This study indicated that Hp infection might be an influential factor in the occurrence of children's allergic purpura,but Hp infection might have no significant effect on the therapeutic effect.
引文
Croche S.B.,Campos E.,Sánchez A.,Arcos L.,Díaz I.,and Toro C.,2016,Henoch-Schonlein purpura involving the penis,a case report,Archivos Argentinos De Pediatria,114(4):e249
Deng Z.,Yang Z.,Ma X.,Tian X.,Bi L.,Guo B.,Wen W.,Han H.,Huang Y.,and Zhang S.,2018,Urinary metal and metalloid biomarker study of Henoch-Schonlein purpura nephritisusing inductively coupled plasma orthogonal acceleration time-of-flight mass spectrometry,Talanta,178:728-735
Elmas A.T.,and Tabel Y.,2016,Platelet counts in children with Henoch-Schonlein purpura-relationship to renal involvement,Journal of Clinical Laboratory Analysis,30(1):71-74
Grabska-Kobylecka I.,Nowak D.,Wlodarczyk A.,and Bialasiewicz P.,2016,No impairment of pulmonary function in children with Henoch-Schonlein purpura after 4-year follow-up,Clinical Rheumatology,35(11):1-4
Gupta V.,Aggarwal A.,Gupta R.,Chandra Chowdhury A.,Agarwal V.,Lawrence A.,and Misra R.,2017,Differences between adult and pediatric onset Henoch-Schonlein purpura from North India,International Journal of Rheumatic Diseases,21(2):292-298
Huang L.,Liu A.M.,Dai Y.W.,Fu H.D.,Wang J.J.,and Mao J.H.,2015,Clinical analysis of childhood anaphylactoid purpura:report of 760 cases,Zhonghua Pifuke Zazhi(Chinese Journal of Dermatology),48(1):11-14(黄雷,刘爱民,戴宇文,傅海东,王晶晶,毛建华,2015,儿童过敏性紫癜760例临床分析,中华皮肤科杂志,48(1):11-14)
Huang W.H.,Jing W.Y.,and Chen W.,2016,Relationship between Helicobacter pylori infection and allergic purpura and renal damage of children,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),26(10):2367-2369(黄文晖,金微瑛,陈伟,2016,幽门螺杆菌感染与儿童过敏性紫癜及肾损害的相关性研究,中华医院感染学杂志,26(10):2367-2369)
Ichiyama S.,Matayoshi T.,Kaneko T.,Shimizu A.,Osada S.I.,Watanabe A.,Kanzaki A.,Mitsui K.,Tsuruoka S.,Iwakiri K.,Kawana S.,and Saeki H.,2016,Successful multitarget therapy using prednisolone,mizoribine and tacrolimus for Henoch-Schonlein purpura nephritis in children,Journal of Dermatology,44(4):e56-e57
Li Y.F.,and Lu L.,2015,Plasma myeloperoxidase,malondialdehyde,superoxide dismutase,and total anti-oxidant capability of Henoch-Sch觟nlein purpura in children,Linchuang Erke Zazhi(Journal of Clinical Pediatrics),14(4):357-360(李玉飞,鹿玲,2015,过敏性紫癜患儿血浆髓过氧化物酶,丙二醛,超氧化物歧化酶及总抗氧化能力水平变化,临床儿科杂志,14(4):357-360)
Liu L.,Zhang D.F.,Li C.Z.,and Liu F.J.,2015,Clinical and pathological analysis in children with Henoch-Sch觟nlein purpura nephritis,Linchuang Erke Zazhi(Journal of Clinical Pediatrics),7(2):151-154(刘玲,张东风,李春珍,刘福娟,2015,儿童过敏性紫癜肾炎的临床及病理分析,临床儿科杂志,7(2):151-154)
Liu L.J.,Yu J.,and Li Y.N.,2015,Clinical characteristics of Henoch-Sch觟nlein purpura in children,Zhongguo Dangdai Erke Zazhi(Chinese Journal of Contemporary Pediatrics),12(10):1079-1083(刘丽君,于静,李宇宁,2015,儿童过敏性紫癜325例回顾性分析,中国当代儿科杂志,12(10):1079-1083)
Ma L.Y.,Zheng D.D.,Yue Y.T.,Zhang L.,Yan C.M.,and Liang L.J.,2016,Curative effect of different types of helicobacter pylori infection on Henoch-Sch觟nlein purpura in children,Ningxia Yike Daxue Xuebao(Journal of Ningxia Medical University),38(11):1241-1244(马立燕,郑丹丹,岳玉婷,张兰,闫春梅,梁丽俊,2016,儿童过敏性紫癜与幽门螺杆菌感染类型的关系及疗效研究,宁夏医科大学学报,38(11):1241-1244)
Mohebbi M.R.,and Bilauca F.F.,2016,Henoch-Sch觟nlein purpura:pressure-dependent or gravity-dependent?Journal of Pediatrics,176:213-213
Purevdorj N.,Mu Y.,Gu Y.,Zheng F.,Wang R.,Yu J.,and Sun X.,2017,Clinical significance of the serum biomarker index detection in children with Henoch-Sch觟nlein purpura,Clinical Biochemistry,52:167-170
Reakatanan W.,Kadegasem P.,Chunharas A.,Tapaneya-Olarn W.,Treepongkaruna S.,and Sirachainan N.,2016,High D-dimer level in Henoch-Sch觟nlein purpura with pancreatitis,Pancreas,45(1):e4-e5
Ruperto N.,Ozen S.,Pistorio A.,Dolezalova P.,Brogan P.,Cabral D.A.,Cuttica R.,Khubchandani R.,Lovell D.J.,O'Neil K.M.,Quartier P.,Ravelli A.,Iusan S.M.,Filocamo G.,Magalh觔es C.S.,Unsal E.,Oliveira S.,Bracaglia C.,Bagga A.,Stanevicha V.,Manzoni S.M.,Pratsidou P.,Lepore L.,Espada G.,Kone-Paut I.,Zulian F.,Barone P.,Bircan Z.,Maldonado Mdel R.,Russo R.,Vilca I.,Tullus K.,Cimaz R.,Horneff G.,Anton J.,Garay S.,Nielsen S.,Barbano G.,Martini A.,and Paediatric Rheumatology International Trials Organisation(PRINTO),2010,EULAR/PRINT-O/PRES criteria for Henoch-Sch觟nlein purpura,childhood polyarteritis nodosa,childhood Wegener granulomatosis and childhood Takayasu arteritis:Ankara 2008,Part I:Overall methodology and clinical characterization,Annals of the Rheumatic Diseases,69(5):798-806
Sgantzos M.,Tsoucalas G.,Karamanou M.,Giatsiou S.,Tsoukalas I.,and Androutsos G.,2015,Hippocrates on pediatric dermatology,Pediatric Dermatol.,32(5):600-603
Shi X.,Li W.C.,Mo L.J.,Li X.H.,Luo Y.Z.,Qin L.Q.,Yang Z.,and Mo W.N.,2018,ANNALS EXPRESS:Altered mean platelet volume in children with Henoch-Sch觟nlein purpura and its association with disease activity,Annals of Clinical Biochemistry,55(3):368-372
Shu J.Y.,Long X.L.,Zhang Q.S.,and Pan X.F.,2016,Helicobacter pylori infection on the renal function in children with Henoch Sch觟nlein purpura,Wannan Yixueyuan Xuebao(Acta Academiae Medicinae Wannan),35(2):148-150(舒建义,龙晓玲,张泉山,潘晓芬,2016,幽门螺旋杆菌感染对过敏性紫癜患儿肾功能的影响,皖南医学院学报,35(2):148-150)
Tang P.R.,Zhu M.H.,Zhong L.X.,and Hu X.,2015,Risk factors analysis of children Henoch-Sch觟nlein purpura,Xueshuan Yu Zhixuexue(Chinese Journal of Thrombosis and Hemostasis),21(4):237-239,242(唐普润,朱美华,钟乐璇,胡湘,2015,儿童过敏性紫癜的危险因素分析,血栓与止血学,21(4):237-239,242)
Teng X.,Gao C.,Sun M.,and Wu J.,2017,Clinical significance of fecal calprotectin for the early diagnosis of abdominal type of Henoch-Sch觟nlein purpura in children,Clinical Rheumatology,37(1):1-7
Teng X.,Wang Y.,Lin N.,Sun M.,and Wu J.,2016,Evaluation of serum procalcitonin and C-reactive protein levels as biomarkers of Henoch-Sch觟nlein purpura in pediatric patients,Clinical Rheumatology,35(3):1-5
Xu H.,Li W.,Mao J.H.,and Pan Y.X.,2017,Association between red blood cell distribution width and Henoch-Sch觟nlein purpura nephritis,Medicine,96(23):e7091
Xu H.,Pan Y.,Li W.,Fu H.,Zhang J.,Shen H.,and Han X.,2016,Association between IL17A and IL17F polymorphisms and risk of Henoch-Sch觟nlein purpura in Chinese children,Rheumatology International,36(6):829-835
Yamada M.,Yamada K.,and Fujinami H.,2016,Colonoscopic reduction of colo-colic intussusception in an adult with immunoglobulin a vasculitis(Henoch-sch觟nlein purpura),Digestive Endoscopy,28(1):101
Yamakawa T.,Yamamoto I.,Komatsuzaki Y.,Niikura T.,Okabayashi Y.,Katsumata H.,Kawabe M.,Katsuma A.,Mafune A.,Nakada Y.,Kobayashi A.,Koike Y.,Miki J.,Yamada H.,Tanno Y.,Ohkido I.,Tsuboi N.,Yamamoto H.,and Yokoo T.,2016,Successful treatment of recurrent HenochSch觟nlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy:a case report,Nephrology,21(S1):53-56
Ye Q.,Shao W.X.,Ye Y.H.,Shang S.Q.,and Han W.Z.,2015,The laboratory differential diagnosis of Henoch-Sch觟nlein purpura,Zhonghua Jianyan Yixue Zazhi(Chinese Journal of Laboratory Medicine),38(4):233-237(叶青,邵文霞,叶义花,尚世强,韩文正,2015,过敏性紫癜的实验室鉴别诊断,中华检验医学杂志,38(4):233-237)
Zhang J.,Zeng H.,Wang N.,Tian X.,Dou W.,and Shi P.,2016,Beneficial effects of creatine phosphate sodium for the treatment of Henoch-Sch觟nlein purpura in patients with early renal damage detected using urinary kidney injury molecule-1levels,European Journal of Pediatrics,175(1):1-7
Deng Z.,Yang Z.,Ma X.,Tian X.,Bi L.,Guo B.,Wen W.,Han H.,Huang Y.,and Zhang S.,2018,Urinary metal and metalloid biomarker study of Henoch-Schonlein purpura nephritisusing inductively coupled plasma orthogonal acceleration time-of-flight mass spectrometry,Talanta,178:728-735
Elmas A.T.,and Tabel Y.,2016,Platelet counts in children with Henoch-Schonlein purpura-relationship to renal involvement,Journal of Clinical Laboratory Analysis,30(1):71-74
Grabska-Kobylecka I.,Nowak D.,Wlodarczyk A.,and Bialasiewicz P.,2016,No impairment of pulmonary function in children with Henoch-Schonlein purpura after 4-year follow-up,Clinical Rheumatology,35(11):1-4
Gupta V.,Aggarwal A.,Gupta R.,Chandra Chowdhury A.,Agarwal V.,Lawrence A.,and Misra R.,2017,Differences between adult and pediatric onset Henoch-Schonlein purpura from North India,International Journal of Rheumatic Diseases,21(2):292-298
Huang L.,Liu A.M.,Dai Y.W.,Fu H.D.,Wang J.J.,and Mao J.H.,2015,Clinical analysis of childhood anaphylactoid purpura:report of 760 cases,Zhonghua Pifuke Zazhi(Chinese Journal of Dermatology),48(1):11-14(黄雷,刘爱民,戴宇文,傅海东,王晶晶,毛建华,2015,儿童过敏性紫癜760例临床分析,中华皮肤科杂志,48(1):11-14)
Huang W.H.,Jing W.Y.,and Chen W.,2016,Relationship between Helicobacter pylori infection and allergic purpura and renal damage of children,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),26(10):2367-2369(黄文晖,金微瑛,陈伟,2016,幽门螺杆菌感染与儿童过敏性紫癜及肾损害的相关性研究,中华医院感染学杂志,26(10):2367-2369)
Ichiyama S.,Matayoshi T.,Kaneko T.,Shimizu A.,Osada S.I.,Watanabe A.,Kanzaki A.,Mitsui K.,Tsuruoka S.,Iwakiri K.,Kawana S.,and Saeki H.,2016,Successful multitarget therapy using prednisolone,mizoribine and tacrolimus for Henoch-Schonlein purpura nephritis in children,Journal of Dermatology,44(4):e56-e57
Li Y.F.,and Lu L.,2015,Plasma myeloperoxidase,malondialdehyde,superoxide dismutase,and total anti-oxidant capability of Henoch-Sch觟nlein purpura in children,Linchuang Erke Zazhi(Journal of Clinical Pediatrics),14(4):357-360(李玉飞,鹿玲,2015,过敏性紫癜患儿血浆髓过氧化物酶,丙二醛,超氧化物歧化酶及总抗氧化能力水平变化,临床儿科杂志,14(4):357-360)
Liu L.,Zhang D.F.,Li C.Z.,and Liu F.J.,2015,Clinical and pathological analysis in children with Henoch-Sch觟nlein purpura nephritis,Linchuang Erke Zazhi(Journal of Clinical Pediatrics),7(2):151-154(刘玲,张东风,李春珍,刘福娟,2015,儿童过敏性紫癜肾炎的临床及病理分析,临床儿科杂志,7(2):151-154)
Liu L.J.,Yu J.,and Li Y.N.,2015,Clinical characteristics of Henoch-Sch觟nlein purpura in children,Zhongguo Dangdai Erke Zazhi(Chinese Journal of Contemporary Pediatrics),12(10):1079-1083(刘丽君,于静,李宇宁,2015,儿童过敏性紫癜325例回顾性分析,中国当代儿科杂志,12(10):1079-1083)
Ma L.Y.,Zheng D.D.,Yue Y.T.,Zhang L.,Yan C.M.,and Liang L.J.,2016,Curative effect of different types of helicobacter pylori infection on Henoch-Sch觟nlein purpura in children,Ningxia Yike Daxue Xuebao(Journal of Ningxia Medical University),38(11):1241-1244(马立燕,郑丹丹,岳玉婷,张兰,闫春梅,梁丽俊,2016,儿童过敏性紫癜与幽门螺杆菌感染类型的关系及疗效研究,宁夏医科大学学报,38(11):1241-1244)
Mohebbi M.R.,and Bilauca F.F.,2016,Henoch-Sch觟nlein purpura:pressure-dependent or gravity-dependent?Journal of Pediatrics,176:213-213
Purevdorj N.,Mu Y.,Gu Y.,Zheng F.,Wang R.,Yu J.,and Sun X.,2017,Clinical significance of the serum biomarker index detection in children with Henoch-Sch觟nlein purpura,Clinical Biochemistry,52:167-170
Reakatanan W.,Kadegasem P.,Chunharas A.,Tapaneya-Olarn W.,Treepongkaruna S.,and Sirachainan N.,2016,High D-dimer level in Henoch-Sch觟nlein purpura with pancreatitis,Pancreas,45(1):e4-e5
Ruperto N.,Ozen S.,Pistorio A.,Dolezalova P.,Brogan P.,Cabral D.A.,Cuttica R.,Khubchandani R.,Lovell D.J.,O'Neil K.M.,Quartier P.,Ravelli A.,Iusan S.M.,Filocamo G.,Magalh觔es C.S.,Unsal E.,Oliveira S.,Bracaglia C.,Bagga A.,Stanevicha V.,Manzoni S.M.,Pratsidou P.,Lepore L.,Espada G.,Kone-Paut I.,Zulian F.,Barone P.,Bircan Z.,Maldonado Mdel R.,Russo R.,Vilca I.,Tullus K.,Cimaz R.,Horneff G.,Anton J.,Garay S.,Nielsen S.,Barbano G.,Martini A.,and Paediatric Rheumatology International Trials Organisation(PRINTO),2010,EULAR/PRINT-O/PRES criteria for Henoch-Sch觟nlein purpura,childhood polyarteritis nodosa,childhood Wegener granulomatosis and childhood Takayasu arteritis:Ankara 2008,Part I:Overall methodology and clinical characterization,Annals of the Rheumatic Diseases,69(5):798-806
Sgantzos M.,Tsoucalas G.,Karamanou M.,Giatsiou S.,Tsoukalas I.,and Androutsos G.,2015,Hippocrates on pediatric dermatology,Pediatric Dermatol.,32(5):600-603
Shi X.,Li W.C.,Mo L.J.,Li X.H.,Luo Y.Z.,Qin L.Q.,Yang Z.,and Mo W.N.,2018,ANNALS EXPRESS:Altered mean platelet volume in children with Henoch-Sch觟nlein purpura and its association with disease activity,Annals of Clinical Biochemistry,55(3):368-372
Shu J.Y.,Long X.L.,Zhang Q.S.,and Pan X.F.,2016,Helicobacter pylori infection on the renal function in children with Henoch Sch觟nlein purpura,Wannan Yixueyuan Xuebao(Acta Academiae Medicinae Wannan),35(2):148-150(舒建义,龙晓玲,张泉山,潘晓芬,2016,幽门螺旋杆菌感染对过敏性紫癜患儿肾功能的影响,皖南医学院学报,35(2):148-150)
Tang P.R.,Zhu M.H.,Zhong L.X.,and Hu X.,2015,Risk factors analysis of children Henoch-Sch觟nlein purpura,Xueshuan Yu Zhixuexue(Chinese Journal of Thrombosis and Hemostasis),21(4):237-239,242(唐普润,朱美华,钟乐璇,胡湘,2015,儿童过敏性紫癜的危险因素分析,血栓与止血学,21(4):237-239,242)
Teng X.,Gao C.,Sun M.,and Wu J.,2017,Clinical significance of fecal calprotectin for the early diagnosis of abdominal type of Henoch-Sch觟nlein purpura in children,Clinical Rheumatology,37(1):1-7
Teng X.,Wang Y.,Lin N.,Sun M.,and Wu J.,2016,Evaluation of serum procalcitonin and C-reactive protein levels as biomarkers of Henoch-Sch觟nlein purpura in pediatric patients,Clinical Rheumatology,35(3):1-5
Xu H.,Li W.,Mao J.H.,and Pan Y.X.,2017,Association between red blood cell distribution width and Henoch-Sch觟nlein purpura nephritis,Medicine,96(23):e7091
Xu H.,Pan Y.,Li W.,Fu H.,Zhang J.,Shen H.,and Han X.,2016,Association between IL17A and IL17F polymorphisms and risk of Henoch-Sch觟nlein purpura in Chinese children,Rheumatology International,36(6):829-835
Yamada M.,Yamada K.,and Fujinami H.,2016,Colonoscopic reduction of colo-colic intussusception in an adult with immunoglobulin a vasculitis(Henoch-sch觟nlein purpura),Digestive Endoscopy,28(1):101
Yamakawa T.,Yamamoto I.,Komatsuzaki Y.,Niikura T.,Okabayashi Y.,Katsumata H.,Kawabe M.,Katsuma A.,Mafune A.,Nakada Y.,Kobayashi A.,Koike Y.,Miki J.,Yamada H.,Tanno Y.,Ohkido I.,Tsuboi N.,Yamamoto H.,and Yokoo T.,2016,Successful treatment of recurrent HenochSch觟nlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy:a case report,Nephrology,21(S1):53-56
Ye Q.,Shao W.X.,Ye Y.H.,Shang S.Q.,and Han W.Z.,2015,The laboratory differential diagnosis of Henoch-Sch觟nlein purpura,Zhonghua Jianyan Yixue Zazhi(Chinese Journal of Laboratory Medicine),38(4):233-237(叶青,邵文霞,叶义花,尚世强,韩文正,2015,过敏性紫癜的实验室鉴别诊断,中华检验医学杂志,38(4):233-237)
Zhang J.,Zeng H.,Wang N.,Tian X.,Dou W.,and Shi P.,2016,Beneficial effects of creatine phosphate sodium for the treatment of Henoch-Sch觟nlein purpura in patients with early renal damage detected using urinary kidney injury molecule-1levels,European Journal of Pediatrics,175(1):1-7