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目的 探讨过敏性紫癜 (HSP)患儿肾损害早期诊断的实验室指标及早期干预的临床疗效。方法 对 50例多次尿常规检查正常的 HSP患儿通过检测尿微量蛋白 (Ig G,MA,TRF,α1 - m G,β2 - m G)及尿酶 (NAG,γ- GT)的含量。采用对比研究方法 ,将 45例异常的 HSP患儿随机分成两组。两组均在甲氰咪胍 ,维生素 C,克敏能 ,钙剂等综合治疗的基础上。A组 (干预组 ) 2 2例加用肝素钠皮下注射 ,甘利欣口服治疗。B组 (对照组 ) 2 3例 ,未加任何处理。结果 多次尿常规正常的 HSP患儿肾损害占 90 %。干预组治疗后 2个月、 4个月尿微量蛋白 ,尿酶各指标均较治疗前降低 ,差异有显著性 (P<0 .0 5或 P<0 .0 1 )。对照组治疗 4个月尿 Ig G,MA,β2 - m G,NAG,γ- GT等较治疗前降低 ,差异有显著性 (P<0 .0 1 )。但干预组治疗 2个月 ,4个月尿微量蛋白 ,尿酶各指标均较对照组低 ,差异有显著性 (P<0 .0 5或 P<0 .0 1 )。尿 Ig G、MA、TRF、NAG恢复较快 ,干预组治疗 4个月时已基本接近正常。而尿 α1 - m G、β2 - m G、γ- GT恢复较慢 ,干预组治疗 4个月时 ,仍有轻重不一的异常。两组治疗 4个月时 ,出现尿常规异常者 ,对照组较干预组高 ,差异有显著性 (P<0 .0 5)。结论 尿微量蛋白 ,尿酶是早期诊断 HSP肾损害的良好指标。用肝素钠
Objective To investigate the laboratory indexes of early diagnosis of renal damage in children with Henoch-Schonlein purpura (HSP) and the clinical effect of early intervention. Methods The levels of urinary microalbumin (Ig G, MA, TRF, α1 - m G, β2 - m G) and urinary enzyme (NAG, γ - GT) were determined in 50 children with normal urinalysis. 45 cases of abnormal HSP were randomly divided into two groups according to the comparative study. Both groups were on the basis of cimetidine, vitamin C, clenbuterol, calcium and other comprehensive treatment. Group A (intervention group) 22 cases plus heparin sodium subcutaneous injection, Gan Lixin oral treatment. Group B (control group) 23 cases without any treatment. The results of urinary routine multiple urinary tract patients with renal damage accounted for 90%. The indexes of urinary microalbuminuria and urease in intervention group at 2 months and 4 months after treatment were lower than those before treatment, the difference was significant (P <0.05 or P <0.01). The urinary GG, MA, β2 - mG, NAG and γ - GT in the control group for 4 months were lower than those before treatment, the difference was significant (P <0.01). However, the indexes of urinary microalbuminuria and urease in intervention group were lower than those in control group at 2 months and 4 months (P <0.05 or P <0.01). Urine Ig G, MA, TRF, NAG recovery faster, intervention group 4 months after treatment has been close to normal. Urine α1 - m G, β2 - m G, γ - GT recovery slower, intervention group 4 months after treatment, there are still varying degrees of abnormalities. When the two groups were treated for 4 months, the patients with abnormal urinary system appeared to be higher in the control group than in the intervention group (P <0.05). Conclusion Urinary microalbuminuria and urease are good indicators of early diagnosis of renal damage in HSP. With heparin