探讨儿童过敏性紫癜中ASO阳性与阴性患儿的临床及实验室特征差异

Differences of Clinical and Laboratory Features between Positive andNnegative ASO in Children with Henoch-Schonlein Purpura

目的:旨在深入探讨链球菌感染与过敏性紫癜患儿分型与临床及实验室指标的关系。方法:纳入2021年1月至2023年12月南京市高淳人民医院78例确诊为HSP的住院患儿,将患儿分为ASO阳性组和ASO阴性组,记录患儿的发病情况及相关实验室指标,分析两组之间的差异。进一步将患儿按不同临床型分为单纯型、关节型、腹型、肾型、混合型;同时选择同期在该医院体检的50名健康儿童作为对照组。收集所有患儿血清,检测抗体IgG和IgM、C4补体水平,并进行咽拭子培养,探究链球菌感染与HSP分型的相关性。结果:在临床与实验室指标比较方面,ASO阳性组的患者年龄明显高于ASO阴性组,在血清白蛋白水平方面,ASO阳性组(26.73±5.22g/L)显著高于ASO阴性组(23.45±4.88g/L)(P<0.05)。而尿素和血肌酐水平方面,两组之间差异无统计学意义(P>0.05)。在免疫球蛋白和补体水平中,只有IgA在两组之间差异有统计学意义(P<0.05);在不同分型患儿抗体水平比较方面,各分型患儿的IgG水平与对照组之间,IgM水平在不同分型组别与对照组之间有统计学意义(P<0.05),在不同分型患儿补体水平比较中,各分型患儿的C4水平与对照组之间无统计学意义(P>0.05);对照组中乙型溶血性链球菌占1例(2.00%),草绿色链球菌占25例(50.00%)。各分型患儿中,不同类型的链球菌分布存在差异,在单纯型中,乙型溶血性链球菌占15.78%,草绿色链球菌占78.94%。在关节型、腹型、肾型和混合型中,乙型溶血性链球菌和草绿色链球菌的分布也各自不同。结论:链球菌感染与HSP患儿的分型之间存在相关性,ASO滴度与患儿临床特征及实验室指标存在相关性。

Objective:To explore the correlation between streptococcal infections and the various classifications of Henoch-Sch nlein Purpura(HSP)in children,focusing on associated clinical and laboratory parameters.Methods:From January 2021 to December 2023,78 children diagnosed with HSP at Nanjing Gaochun People's Hospital were enrolled.They were divided into ASO positive and ASO negative groups for analysis of incidence rates and laboratory indicators.The children were further classified based on clinical manifestations into simple,joint,abdominal,renal,and mixed types.Additionally,50 healthy children undergoing routine physical examinations at the same hospital were included as controls.Serum samples from all participants were tested for IgG and IgM antibodies,C4 complement levels,and throat swab cultures were performed to determine the relationship between streptococcal infection and HSP types.Results:The ASO positive group,generally older,showed significantly higher serum albumin levels(26.73±5.22 g/L)than the ASO negative group(23.45±4.88 g/L)(P<0.05),with no marked differences in urea and creatinine levels between the groups(P>0.05).Among immunoglobulin and complement levels,only IgA showed significant differences(P<0.05).IgG levels did not significantly vary among different HSP subtypes compared to controls,while IgM levels displayed significant differences(P<0.05).C4 levels were consistent across subtypes and controls(P>0.05).In terms of streptococcal types,type B hemolytic streptococcus appeared in 2.00%of the control group,and grass green streptococcus in 50.00%.Each HSP subtype had a distinct distribution of these bacteria,with type B hemolytic and grass green streptococci showing variable prevalence among the joint,abdominal,renal,and mixed types.Conclusion:This study substantiates a significant link between streptococcal infections and the subtypes of allergic purpura(HSP)in pediatric patients.The association of ASO titers with specific clinical features and laboratory markers underscores the critical role of streptococcal infection consideration in the diagnostic and treatment strategies for HSP.This underscores the need for vigilant monitoring and management of streptococcal infections to optimize outcomes for children with HSP.