肺炎支原体、衣原体与小儿过敏性紫癜的关系

河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下，由本人独立完成。本学位论文研究所获的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文，第一署名单位为河北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应的法律责任。研究生签名： 导师 二级学院瑚辉河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外，文中不包含其他人己经发表或撰写的研究成果，指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名：互丧槠导师签章：二p，弓年三月才日目 录中文摘要!1英文摘要4研究论文 肺炎支原体、衣原体与,J、JL过敏性紫癜的关系前言7翮舌“一”一“一”“一“”“”一“”一”“一“”一“”一一”一”7材料与方法7结果10附表“一一”一”t一一一“12讨论14结论”20参考文献20综述感染触发儿童过敏性紫癜发病机制的研究24致谢0 0 9 0 0 033个人简历34中文摘要肺炎支原体、衣原体与小儿过敏性紫癜的关系摘 要目的：探讨肺炎支原体、衣原体与d,JL过敏性紫癜的相关性，来更好的指导临床用药；从而减少此病迁延反复性、降低对肾脏损伤的几率。方法：收集于2012年9月一2013年2月在河北医科大学第二医院儿科住院治疗的80例首发的过敏性紫癜患儿为研究对像，其中男孩48例，女孩32例，年龄范围在3-15岁，详细记录患儿发病时间、病程、皮疹消退时间、腹痛及各关节肿痛消失时间、尿中红细胞和尿蛋白的变化以及随诊中患儿疾病反复的情况。从患儿开始起病7天内，取患儿静脉血2ml，不抗凝、在4。C环境下静置1小时，待血液凝固后行间接免疫荧光法检测血清中肺炎支原体、衣原体的IgM抗体。对其肺炎支原体、衣原体IgM阳性的HSP患儿设置为观察组，IgM阴性的HSP患儿设置为对照组。，两组患儿在性别及年龄上经统计学检验差异无显著性(胗0os)，具有可比性。对两组伴有发热、上呼吸道感染或者支气管炎、肺炎的患儿均予以抗感染(青霉素类或头孢类)治疗，并比较两组患儿皮疹消退时间及住院时间的长短，腹痛、关节肿痛、肾损伤各临床表现以及病情迁延反复(皮疹反复2次)的分布情况。同时对两组进行常规治疗(卧床休息，忌异型蛋白饮食，口服西替利嗪、双嘧达莫，低分子肝素钙，VitC，及活血化瘀药物。有消化道、关节症状者均短期予氢化考的松静点，有肾损伤者可口服醋酸泼尼松并加用雷公藤多苷等免疫抑制剂)，对于观察组即支原体，衣原体阳性组加用大环内酯类药物；即阿奇霉素按疗程(1 0mg(kgd)，5天后停用2天，改为口服阿奇霉素10mg(kgd)，服3天停4天，总疗程不少于34周)，观察其疾病的转归情况。所有统计学分析均采用SPSS 130统计学软件，正态分布计量资料采用均数4-标准差(x土S)表示，两组间比较用t检验；非正态分布资料采用中位数(四分位数间距)懒Q)，两组间比较时采用非参数法；对于计数资料，两组间率(或构成比)进行比较时采用卡方检验。设定0t=005尸005)。4两组患儿年龄大小的比较：观察组的年龄为827+0367岁、对照组的年龄为845+0545岁，二者之间无统计学差异(t=-0273，PO05)。5两组患儿皮疹消退时间的比较：观察组的中位数(四分位数间距)是10(55)对照组中位数(四分位数间距)是8(3)，两组之间比较有统计学差异(Z=352，P005)，观察组皮疹消退时间明显长于对照组。6观察组与对照组住院天数的比较：观察组与对照组住院天数分别为1 534+067天、1 259-a：0357天，二者之间有统计学差异(t-3632,P005)，观察组住院天数明显长于对照组。7两组患儿临床表现的比较(包括有无腹痛、关节痛、病情有无迁延)：观察组存在腹痛的有17例，对照组有11例，两组之间进行比较有统计学差异(X2=11156，P005)。观察组病情迁延的有9例，对照组有5例，两组间进行比较有统计学差异(X2=5772，P=2)in two groupsThe date was analyzed by spss l 30Normal distribution and expressed by x+SThe difference between twogroups was analyzed by t-testSkewed distribution and expressed by median，nle difference between two groups was analyzed by nonparametric methodTo enumeration data，used Chi square test to analyze constituent ratio betweentwo groupsSet仅=O05，the value of氏O05 was regarded as statistical一4英文摘要significanceResults：1 The samples were collected from 80 patients，included 48 boysand 32 girls；the age WaS from 3 to 1 5 years oldTherefore，HSP used toappear mostly in school age children and male female ratio was 15：1Thepercentage rates for patients who had infection were 5 125All 80 patientshad skin purpura which mostly symmetrical appeared at extensor arms，legsand buttocksThe patients who had skin purpura as primary symptom WaS 29(3525)，digestive symptoms WaS 28(35)which included 5 blood stools(+_抖)，articulus pain WaS 1 5(1 875)，urine protein(+斗+)and RBC(+十H)WaS 8(10)，relapse was 12(15)There were 7 of the 12 relapsepatients who got anaphylactic purpura nephritis in follow up2 All the patients had taken the test of blood IgM for Mycoplasma pneumoniaand Chlamydia pneumoniaThe percentage of the positive for Mycoplasmapneumonia was3625(2980)，and for Chlamydia pneumonia Was 25(280)，There Was no mixed infection3 The gender formation of observation group and control group：there were 1 8boys and 1 1 girls in observation group；and 3 0 boys and 2 1 sirls in controlgroupCompared the two groups，the value of胗005 WaS not regarded asstatistical significance(X2=O08 1，P005)4 The age of observation group and control group：the average age ofobservation group is 827+0367，the average age of control group is845+0545Compared the two groups，the value of P005 Was not regardedas statistical significance(t-0273，PO05 05 The persistent period of skin purpura of observation group and control group：the median of observation group is 1 0(55)and the median of control group is8(3)Compared the two groups，the value of PO05 Was regarded asstatistical significance(Z=-352，Po05)Skin purpura ofobservation grouplasts longer than contr01 group6 The hospital stays of observation group and control group：the hospital staysof the observation group was 1 534士067 days and the control group is1259士0357 daysCompared the two groups，the value of氏O05 wasregarded as statistical significance (芦3632,P005)The hospital staysofobservation group was longer than con们l踟7 The cliIlical manifes僦on；such as digestive symptoms，articulus pareandrelapse in follow up；of observation group and control group：the pati邮whohad digestive symptoms in observation group was 1 7 and con们l印up was1 1Com邮d the two groups，the value of PO05 Was regarded as statistlCalsignific舭Ce(X2=1 11 56，P005 was not regarded as statistical significance(X2：233 1，PO05)The patients who relapsed in follow up in observation邮lup were 9 and control group was 5Compared the two groupsthe Value ofPO05)Obseation group had more patients who relapsed in follow up than controlCon试usion：1 There was no difference of mycoplasma pne眦0nlainfection翰te in different gender and age of anaphylactoid puipura patients2 m positive of IgM for Chlamydia pneumonia was less than Myc叩1asmapnelm】oniaClll钺nydia pneumonia also Can be on of the pathogenic factorsofHSP,however,not the primary one3 Anaphyl actIDid puipura caused by mycoplasma pneumoma had long钉perSi删period of skin purpura，longer hospital stays and more patients wn0had dige s|tiVe symptoms and relapse in follow upTherefore，mycopl硒mapne啪onia made锄aphylaCtoid puipura more complicatedKeywords：Chlamydia pneumonia；Mycoplasma pneur】Aoma；Anaphylactoid puipura；HSP；IgM Antibody；Children研究论文肺炎支原体、衣原体与小儿过敏性紫癜的关系圣知 古莉 吾过敏性紫癜(Anaphylactoid Purpura)是一种自身免疫反应所介导的全身性血管炎，其主要病理变化是全身广泛小血管壁上可见大量的Ig