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目的:探讨外周血血小板参数及D-二聚体水平在儿童过敏性紫癜(Henoch-Schonlein purpura,HSP)的变化及临床意义。方法:选择2010年6月至2012年5月间青岛大学医学院附属医院儿科住院过敏性紫癜患儿137例为研究对象,儿童保健科健康查体儿童50例为对照组。血小板参数包括血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板体积分布宽度(PDW),采用XE-2100全血细胞分析仪、电阻抗法检测;血浆D-二聚体采用胶乳比浊法检测。结果:与对照组比较,HSP患儿急性期外周血PLT、PCT显著升高(P<0.05),而MPV显著降低(P<0.05),PDW无显著差异(P>0.05);有无胃肠道出血HSP组间和有无肾脏受损HSP组间血小板参数并无显著性差异(p>0.05)。84例(61.3%)HSP患儿急性期血浆D-二聚体水平增高,其绝对浓度(中位数)为435 ng/ml,显著高于正常水平(0-300 ng/ml);不同HSP临床表型组间血D-二聚体异常率和绝对浓度均无显著性差异(X2=2.75,P>0.05;H=3.37,P>0.05);合并胃肠道出血组与无消化道出血组比较HSP病儿血浆D-二聚体水平显著升高(Z=-2.691,P<0.05);合并肾损害与无肾损害组比较HSP病儿血浆D-二聚体水平显著降低(Z=-4.063,P<0.05)。结论:HSP患儿急性期血液处于高凝及继发的纤溶状态,早期检测血小板参数及D-二聚体变化水平,指导临床诊断及临床用药。
Objective: To investigate the changes and clinical significance of peripheral blood platelet parameters and D-dimer levels in children with Henoch-Schonlein purpura (HSP). Methods: From June 2010 to May 2012, 137 children with in-hospital allergic purpura in pediatric department of Medical College of Qingdao University were enrolled in this study. Fifty children with physical examination of child health department as control group. Platelet parameters included platelet count (PLT), mean platelet volume (MPV), platelet pressure (PCT), platelet volume distribution width (PDW), using XE-2100 whole blood cell analyzer, Body latex latex turbidimetry test. Results: Compared with the control group, the levels of PLT and PCT in peripheral blood of HSP patients increased significantly (P <0.05) and MPV significantly decreased (P <0.05), PDW showed no significant difference (P> 0.05) There was no significant difference in platelet parameters between hemorrhagic HSP group and HSP group with or without renal injury (p> 0.05). In 84 cases (61.3%) of HSP children, the level of plasma D-dimer in acute phase increased, the absolute concentration (median) was 435 ng / ml, which was significantly higher than the normal level (0-300 ng / ml) There was no significant difference in the abnormal rate of D-dimer and absolute concentration between the clinical phenotype groups (X2 = 2.75, P> 0.05; H = 3.37, P> 0.05) Plasma D-dimer levels were significantly higher in children with HSP compared with those without HSP (Z = -2.691, P <0.05). Plasma D-dimer levels were significantly lower in children with HSP than those without renal damage (Z = -4.063, P <0.05). Conclusion: In the acute stage of HSP, the blood is hypercoagulable and secondary to fibrinolytic state. The early detection of platelet parameters and the level of D-dimer changes may guide the clinical diagnosis and clinical medication.