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題 名 | 類過敏性紫斑症之腎臟侵犯及其與血清免疫球蛋白之關係 |
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作 者 | 邱世欣; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷 期 | 30:4 民78.07-08 |
頁 次 | 頁240-247 |
分類號 | 417.5637 |
關鍵詞 | 類過敏性紫斑症; 腎臟侵犯; 血清免疫球蛋白; |
語 文 | 中文(Chinese) |
中文摘要 | 從1979年8月至1987年8月間,高雄醫學院小兒科共收集了88例類過敏性紫斑症患兒做研究。37例(佔42.0%)有不等程度腎臓侵犯之臨床表現。腎臓侵犯發生之比率與疾病年齡有關,較大之小孩特點輥9歲以上,其腎臓受侵犯之比率較高(68.0% vs 31.7%, P<0.005),其他臨床症狀,包括上呼吸道感染病史、腹痛、關節表現、血便及紫斑復發之有無則和腎臓侵犯無統計上的相關。15例合併高血壓者全部皆有腎臓侵犯,顯示高血壓是腎臓侵犯之一良好指標。腎臓受侵犯病例中,21例(佔56.8)在4星期內完全康復,2例分別於2個月及4個月後康復,10例患兒呈現持續性異常尿超過6個月,另有4例在治療過程中失蹤去追蹤。10例持續性異常尿超過6個月病人中,5例得到緩解,4例持續有異常尿(追蹤15至30個月),1例死亡。共有5例腎臓受侵犯病人(佔13.5%)呈現腎病症侯羣合併腎炎,臨床上較爲嚴重。有44.7%病例血清IgA過高,36.4% IgE過高,兩者與腎臓侵犯無統計上相關。急性期IgA過高且接受追蹤之7例,在恢復期中全部呈現下降,統計上呈有意義變化(P<0.05)。急性期IgE過高且接受追蹤之6例,在恢復期中有83.3%呈現下降,統計上呈有意義變化(P<0.05)。IgM在14.5病例中呈現過高,IgG在8.5%病例中呈現過高。IgE在類過敏性紫斑症之角色,值得做進一步研究。共有49例接受血清抗核抗體檢查,中有2例呈現陽性反應,41列接受抗鏈菌溶血素O檢查,中有13例(佔31.7%)呈現昇高,但與腎臓侵犯與否無統計上相關。腎臓侵犯之預後上,與血清IgA,IgE過高,合併鏈球菌感染之有無皆沒有統計相關。 |
英文摘要 | Eighty-eight children of anaphylactoid purpura were studied in the Department of Pediatrics from September 1997 to September 1987. Fifty-one children without renal involvement recovered rapidly. Seven children with hematuria or proteinuria and fourteen children with both manifestations recovered fully within six weeks also. Two patients with hematuria and proteinuria recovered two months and four months, respectively, after diagnosis. Then children had persistent hematuria and proteinuria lasting for more than six months; of these five children recovered and four improved: one child died of intracranial hemorrhage and severe infection. Nephrotic syndrome was noted in five children. Most of them (>80%) had persistent proteinuria more than six months. Incidence of renal involvement was correlated with age. Older children especially those of more than nine years old had a higher incidence rate (p<0.005). Serum immunoglobulin A (IgA) and immunoglobulin E (IgE) levels were significantly elevated in 44.7% and 36.4% of patients respectively, but neither influenced the incidence of renal involvement or prognosis of renal disease. Elevated serum IgA and IgE levels in acute stage were significantly reduced in 100% and 83% of children when they were followed in convalescent stage (p<0.05). The role of IgE) deserves further study. Antinuclear antibody was Positive in two children without nephritis. Hypertension was noted in fifteen children, all with renal involvement. Hypertension appears to be a good indicator for renal involvement. Antistreptolysin O titer was elevated in 31.7% of children, but had no significant correlation with incidence of renal involvement. |
本系統中英文摘要資訊取自各篇刊載內容。