第一临床医学院知识库

目的：研究儿童过敏性紫癜（Henoch-Schonlein Purpura，HSP）临床症状与相关实验室指标的关系，探讨HSP患儿相关实验室指标对HSP发生消化道出血的预测价值，以尽早识别可能发生不良并发症的患儿，以便医务人员尽早发现，尽早干预，从而降低HSP患儿发生消化道出血的风险。

方法：收集2014年5月至2016年5月期间在兰州大学第一医院就诊，首次诊断并收入院治疗的HSP患儿。以148例处于急性期，未经过糖皮质激素及免疫抑制剂治疗，并排外其他感染的HSP患儿为HSP组。同时收集77例因腹痛入院，但经检查后无任何器质性病变的患儿为对照组。两组均在入院当日采集血样，进行血常规、血沉（Erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reactive protein，CRP）等的检测。收集并记录患儿的性别、年龄、住院天数、临床症状、体征及激素的使用情况，并从相关化验检查结果中提取白细胞计数（White blood cell count，WBC）、淋巴细胞绝对值、中性粒细胞绝对值、血红蛋白（Hemoglobin，Hb）、血小板计数（(Platelet count，PLT）、平均血小板体积（Mean platelet volume，MPV）、CRP及ESR的值，计算出中性粒细胞与淋巴细胞绝对值的比值（Neutrophils to lymphocytes ratio，NLR）。

结果：①本研究HSP组共纳入148例HSP患儿，其中男81例，女67例，男与女比例为1.2：1；年龄2～16岁，平均年龄7.7±2.8岁；住院天数2～27天，平均住院6.5（5～9）天；大多冬春季发病；急性期以皮肤紫癜作为首发症状的有143例，以腹痛首发的有3例，以关节肿痛首发的有2例；HSP患儿合并消化道出血者39例，占26.4%，其中因并发肠套叠，并施行外科手术的有1例；经明确诊断后使用激素治疗的患儿111例，占总人数的75%。

② HSP组WBC、中性粒细胞绝对值、NLR、PLT与对照组相比明显升高，淋巴细胞绝对值与对照组相比明显降低，差异具有统计学意义。

③ HSP消化道出血组的WBC、中性粒细胞绝对值、NLR和CRP较非消化道出血组明显升高，淋巴细胞绝对值较非消化道出血组明显降低，差异具有统计学意义。

④ HSP患儿的临床评分与实验室指标WBC（r=0.344，P＜0.001）、中性粒细胞绝对值（r=0.405，P＜0.001）、NLR（r=0.364，P＜0.001）、PLT（r=0.185，P=0.024）及CRP（r=0.258，P=0.002）呈显著正相关。

⑤经Logistic逐步回归分析，CRP及NLR是HSP消化道出血的独立危险因素。

⑥根据ROC曲线下面积结果，与NLR相比，CRP是HSP消化道出血的潜在的更有效的预测指标。

结论：CRP＞7.25mg/L及NLR＞3.43可作为预测儿童HSP消化道出血的简易指标，尤其对腹型HSP并发消化道出血的早期筛查可能具有更好的价值。

Objective:To research the relationship between the clinical symptoms of Henoch-Schonlein Purpura (HSP) and the related laboratory markers, and to explore the predictive value of laboratory markers in HSP related gastrointestinal bleeding of children. As soon as possible to identify the children who may have adverse complications, so that medical personnel can find and intervention early to reduce the incidence of gastrointestinal bleeding in HSP.

Method:Collected the first diagnosis and hospitalization of HSP in children from May 2014 to May 2016 in the first hospital in Lanzhou University, 148 patients were enrolled in HSP group，who were in the acute phase, without glucocorticoid and immunosuppressive therapy, excluded other infections. At the same time, 77 patients of children were collected as the control group, who were hospitalized for abdominal pain and without any organic disease after examination. Both groups were collected blood on the day of admission, and tested blood routine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and so on as usual. To collect and record the sex, age, length of hospital stay, clinical manifestations, clinical signs and the use of hormones of the two groups, and to extract white blood cell count (WBC), lymphocyte absolute value, neutrophil absolute value, hemoglobin (Hb), platelet count (PLT), mean platelet volume (MPV), CRP and ESR, to figure out neutrophils to lymphocytes ratio (NLR).

Results:①Among the 148 children of HSP, 81 cases were male and 67 cases were female, male to female ratio of 1.2: 1. The age ranged from 2 to 16 years with the average age of (7.7 ± 2.8) years. The hospital day ranged from 2 to 27 days with the average length of hospital stay of 6.5(5～9)days, maximum cases with onset in winter and spring. In the acute phase of these children, the skin purpura for the first is 143 cases, with abdominal pain in the first is 3 cases, starting with joint pain is 2 cases; gastrointestinal bleeding in HSP were 39 cases, accounting for 26.4%, of which the occurrence of intussusception, 1 case of surgery. After diagnosis, the uses of hormones were 111 people, accounting for 75% of 148 children of HSP.②WBC, absolute neutrophil count, PLT, and NLR levels were significantly higher in HSP group compared with the control group, absolute lymphocyte count was significantly lower in HSP group (P<0.05).

③WBC, absolute neutrophil count, NLR, and CRP levels were significantly higher in HSP patients with GI bleeding when compared to patients without gastrointestinal bleeding, while absolute lymphocyte count was significantly lower in patients with gastrointestinal bleeding than the patients without gastrointestinal bleeding (P<0.05).

④The total clinical scores of HSP patients were more strongly correlated with WBC (r=0.344, P<0.001), absolute neutrophil count (r=0.405, P<0.001), NLR (r=0.364, P<0.001), PLT (r=0.185, P=0.024), and CRP (r=0.258, P=0.002).

⑤CRP and NLR were the only two indicators associated with gastrointestinal bleeding in HSP in logistic regression analysis.

⑥The area under the ROC curve analysis indicated that CRP could be a more efficient potential predictor of gastrointestinal bleeding in HSP when compared to NLR.

Conclusion:This study suggested that CRP>7.25mg/L jointly with NLR>3.43 might predict gastrointestinal bleeding in HSP better, and should be taken attention in clinical.