过敏性紫癜患儿凝血纤溶系统变化及抗凝治疗效果研究

Detection of Coagulation and Fibrinolysis System in Children with Henoch-schnlein Purpura and the Effect of Anticoagulant Therapy

目的了解过敏性紫癜(HSP)患儿的凝血及纤溶系统变化,并探讨其抗凝治疗效果。方法选取2010年1月—2013年12月厦门市妇幼保健院收治的HSP患儿86例,采用随机数字表法分为A组41例和B组45例;另选取健康儿童40例,作为对照组。A、B组患儿均接受常规治疗,B组患儿在此基础上接受抗凝治疗。比较3组的血小板(PLT)、D-二聚体(D-Dimer)、纤维蛋白原(FIB),以及A、B组临床疗效指标(皮肤紫癜消退时间、腹痛消退时间、关节肿痛消退时间、皮疹反复发生率)、不良反应发生情况。结果治疗前A、B组PLT、D-Dimer,FIB高于对照组(P<0.05)。治疗后B组PLT低于对照组,对照组低于A组(P<0.05);对照组D-Dimer低于B组,B组低于A组(P<0.05);对照组和B组FIB低于A组(P<0.05)。B组皮肤紫癜消退时间、腹痛消退时间、关节肿痛消退时间短于A组,皮疹反复发生率低于A组(P<0.05)。两组治疗期间均无严重出血病例,随访6个月肾炎发生率比较,差异无统计学意义(P>0.05)。结论过敏性紫癜患儿发作期抗凝纤溶系统处于高活动状态,低分子肝素钙抗凝治疗可改善体内凝血纤溶状态,促进病情恢复。

Objective To detection the coagulation and fibrinolysis system in children with henoch - schonlein purpura （HSP）,and to explore the effect of anticoagulant therapy. Methods A total of 86 children with HSP were selected in Xiamen Maternal and Child Health Care Hospital from January 2010 to December 2013 , and they were divided into A group （n =41） and B group （n = 45 ） according to random table method. Another 40 healthy children were selected as control group. Patients in A and B group were all accepted routine treatment, while patients of observation group were treated with anticoagulant therapy on the basis of routine treatment. The PLT, D - Dimer and FIB among three groups, and the clinical effect indexes （ including skin purpura subsided time, abdominal pain subsided time, joint pain subsided time, recurrent rate of skin rash） and adverse reaction conditions were compared between A and B group. Results Before treatment, the PLT, D - Dimer and FIB of A group and B group were statistically significantly higher than that of control group （ P 〈 0. 05 ）. After treatment,the PLT of B group was statistically significantly lower than that of control group, control group was statistically significantly lower than that of A group （P 〈 0. 05 ） ; the D - Dimer of control group was statistically significantly lower than that of B group, B group was statistically significantly lower than that of A group （ P 〈 0. 05 ） ; the FIB of control group and B group was statistically significantly lower than that of A group （ P 〈 0. 05 ）. The skin purpura subsided time, abdominal pain subsided time, joint pain subsided time of B group was statistically significantly shorter than that of A group, the recurrent rate of skin rash of B group was statistically significantly lower than that of A group （ P 〈 0. 05 ）. No serious bleeding cases in the two groups during the treatment period, after six - month follow - up, no statistically significant differences of nephritis incidence rate were found between A group and B group （P 〉 0. 05 ）. Conclusion The anticoagulation and fibrinolytic system of children with HSP are activated. The low molecular weight heparin calcium play an important roles in the process of anticoagulation fibrinolytic system and promote the recovery of the HSP.