血清促胃液素、C_反应蛋白、D_二聚体检测在儿童腹型过敏性紫癜中的临床意义

摘要

目的 探讨血清促胃液素x_17(gastrin_17)、C_反应蛋白(CRP)及D_二聚体(D_D)检测在儿童腹型过敏性紫癜(HSP)早期诊断和病情严重程度判断中的意义.方法 选取2016年12月至2017年12月安徽医科大学第一附属医院儿科一病区住院部收治的120例初发HSP患儿,其中腹型HSP患儿70例,无消化道症状的其他类型HSP患儿50例.选取同期在安徽医科大学第一附属医院门诊健康咨询的20例健康儿童为健康对照组.检测各组患儿急性期血清gastrin_17、CRP及D_D水平,分析三者与紫癜症状评分之间的相关性,结合胃镜检查,评估三者与腹型HSP病情严重程度的关系.结果 1.腹型HSP患儿急性期血清gastrin_17水平明显低于其他类型HSP组及健康对照组[(3. 12 ± 1. 64)pmol/L比(6. 85 ± 1. 28)pmol/L和(7. 15 ± 1. 03)pmol/L],差异均有统计学意义(均P<0. 001);与晚期出现消化道症状腹型HSP组比较,早期出现消化道症状的腹型HSP患儿血清gastrin_17水平降低更为显著[(1. 77 ± 0. 50)pmol/L比(4. 01 ± 1. 51)pmol/L],差异有统计学意义(P<0. 001),其胃镜下病变程度亦较为严重( χ2 =8. 095 2,P<0. 05).2.腹型HSP患儿血清CRP及D_D水平明显高于健康对照组[(18. 39 ± 4. 48)mg/L比(3. 95 ± 1. 65)mg/L;(2. 53 ± 1. 17)mg/L比(0. 59 ± 0. 41) mg/L],差异均有统计学意义(均P<0. 001);与晚期出现消化道症状腹型HSP组比较,早期出现消化道症状的腹型HSP患儿血清CRP及D_D水平升高更为显著[(19. 98 ± 5. 45)mg/L比(17. 33 ± 3. 37)mg/L;(3. 48 ± 0. 96)mg/L比(1. 89 ± 0. 80)mg/L],差异均有统计学意义(均P<0. 05).3.腹型HSP患儿急性期血清gas_trin_17水平与紫癜症状评分呈负相关( r= _0. 907,P<0. 01),血清CRP及D_D水平与紫癜症状评分均呈正相关(r=0. 974、0. 928,均P<0. 01).结论 腹型HSP患儿急性期血清gastrin_17、CRP及D_D水平联合测定可作为早期诊断腹型HSP尤其是早期出现消化道症状的非典型HSP的血清学标志物之一.%Objective To investigate the clinical significance of serum gastrin _17,C _ reactive protein ( CRP)and D_dimer(D_D)levels in early diagnosis and severity evaluation of Henoch_Sch?lein purpura(HSP) children with abdominal symptoms. Methods Retrospective analysis was performed in 120 children with initial HSP admitted to the Department of Pediatrics,the First Affiliated Hospital of Anhui medical University from December 2016 to December 2017,among them,there were 70 cases with abdominal symptoms,and 50 patients without abdominal symptoms. And 20 healthy children who underwent health consultation at the First Affiliated Hospital of Anhui medical University were selected as a healthy control group. Serum gastrin_17,CRP and D_D levels in acute phase in the HSP children were detected,and the correlation between these parameters and purpura symptom scores was analyzed. Together with gastroscope,the severity of HSP with abdominal symptoms was evaluated. Results (1)Serum gastrin_17 level in HSP children with abdominal symptoms were obviously lower than that of the other of type HSP group and the healthy control group[(3. 12 ± 1. 64)pmol/L υs.(6. 85 ± 1. 28)pmol/L and(7. 15 ± 1. 03)pmol/L],and the differences were statistically significant(all P<0. 001);the levels were decreased most significantly in HSP children with early gastrointestinal symptoms[(1. 77 ± 0. 50)pmol/L υs.(4. 01 ± 1. 51)pmol/L],and the difference was sta_tistically significant(P<0. 001);the pathological changes under gastroscope were obvious in HSP children with early gastrointestinal symptoms(χ2 =8. 095 2,P<0. 05).(2)Serum CRP and D_D levels in the HSP children with abdo_minal symptoms were striking higher than those in the healthy control group[(18. 39 ± 4. 48)mg/L υs.(3. 95 ± 1. 65) mg/L;(2. 53 ± 1. 17)mg/L υs.(0. 59 ± 0. 41)mg/L],and the differences were statistically significant( all P <0. 001 ),which were both increased most significantly in the HSP children with early gastrointestinal symptoms [(19. 98 ± 5. 45)mg/L υs.(17. 33 ± 3. 37)mg/L;(3. 48 ± 0. 96)mg/L υs.(1. 89 ± 0. 80)mg/L],and the diffe_rences were statistically significant(all P<0. 05).(3)Serum gastrin_17 level was negatively correlated with purpura symptom scores(r= _0. 907,P<0. 01);serum CRP and D_D levels were both positively correlated with purpura symptom scores(r=0. 974,0. 928,all P<0. 01). Conclusions Serum gastrin_17,CRP and D_D levels in acute phase can be used as serological markers for early diagnosis of HSP children with abdominal symptoms,especially in HSP children with early gastrointestinal symptoms.