儿童过敏性紫癜复发相关因素回归分析及其临床管理方案研究-现代医学

儿童过敏性紫癜复发相关因素回归分析及其临床管理方案研究

单位：重庆医科大学附属儿童医院宜宾医院儿内二科, 四川宜宾 644600

分类号：R725.5

出版年·卷·期（页码）：2025·53·第八期（1291-1297）

摘要：

目的：探讨儿童过敏性紫癜复发相关因素回归分析及其临床管理方案。方法: 选取2021年1月至 2024年4月过敏性紫癜患儿150例为研究对象，通过收集临床及随访数据，根据出院后是否复发过敏性紫癜分为未复发组(n=103)和复发组(n=47)。多因素Logistic回归分析影响过敏性紫癜复发的因素;采用受试者工作特征曲线(ROC)分析影响因素对过敏性紫癜复发的预测效能，并根据影响复发因素制定临床管理方案。结果：未复发组和复发组在尿潜血、激素使用、皮疹缓解时间、出院后饮食控制、运动限制、口服免疫调节剂、口服激素、C-反应蛋白(CRP)、血小板计数(PLT)方面差异有统计学意义(P＜0.05)。多因素 Logistic 回归分析显示，出院后有饮食控制、运动限制、口服免疫调节剂、PLT水平高是影响儿童过敏性紫癜复发的保护因素(P<0.05)，出院后口服激素是影响儿童过敏性紫癜复发的危险因素(P<0.05)。以ROC曲线分析影响因素对儿童过敏性紫癜复发的预测价值，结果显示，出院后饮食控制、运动限制、口服免疫调节剂、口服激素、PLT、联合预测的曲线下面积(AUC)分别为0.699(95%CI 0.600~0.799)、0.764(95%CI 0.672~0.856)、0.594(95%CI 0.501~0.687)、0.622(95%CI 0.523~0.722)、0.618(95%CI 0.523~0.714)、0.907(95%CI 0.853~0.961)，提示出院后饮食控制、运动限制、口服免疫调节剂、口服激素、PLT对过敏性紫癜复发有一定预测价值，联合预测具有较高预测价值。结论：家属应严格遵循医生制定的饮食计划，避免摄入可能诱发过敏的食物，合理安排运动量及运动类型，严格按照医生指导进行用药，定期进行血常规检测，以及时发现并处理异常情况。

Objective: To explore the regression analysis of related factors for recurrence of Henoch-Schonlein purpura in children and its clinical management scheme. Methods: A total of 150 children with Henoch-Schonlein purpura from January 2021 to April 2024 were enrolled. The clinical and follow-up data of the patients were collected. They were divided into non-recurrence group(103 cases) and recurrence group(47 cases) according to the presence or absence of recurrence of Henoch-Schonlein purpura after discharge. The multivariate Logistic regression analysis was performed to analyze the factors affecting the recurrence of Henoch-Schonlein purpura. Receiver operating characteristic curve(ROC) was used to analyze the predictive efficacy of influencing factors for recurrent Henoch-Schonlein purpura. The clinical management plan was formulated according to the factors affecting recurrence. Results: There were statistically significant differences between the non-recurrence group and the recurrence group in terms of urine occult blood, hormone use, rash remission time, diet control after discharge, exercise restriction after discharge, oral immunomodulator after discharge, oral hormone after discharge, C-reactive protein(CRP), and platelet count(PLT)(P<0.05). Multivariate Logistic regression analysis showed that diet control, exercise restriction, oral immunomodulator, and high PLT level after discharge were protective factors affecting the recurrence of allergic purpura in children(P<0.05), and oral hormone administration after discharge was a risk factor affecting the recurrence of allergic purpura in children(P<0.05). The ROC curve was used to analyze the predictive value of influencing factors for the recurrence of allergic purpura in children. The results showed that the areas under the curve(AUC) of diet control, exercise restriction, oral immunomodulators and oral hormones after discharge, PLT and combined prediction were 0.699(95%CI 0.600-0.799), 0.764(95%CI 0.672-0.856), and 0.594(95%CI 0.501-0.687), 0.622(95%CI 0.523-0.722), 0.618(95%CI 0.523-0.714) and 0.907(95%CI 0.853-0.961) respectively. It suggested that dietary control, exercise restriction, oral administration of immunomodulators and oral administration of hormones after discharge, and PLT had certain predictive value for the recurrence of Henoch-Schonlein purpura. The combined prediction had a relatively high predictive value. Conclusion: Family members should strictly follow the diet plan formulated by the doctor, avoid eating foods that may induce allergies, arrange the amount and type of exercise reasonably, take drugs strictly according to the instructions of doctors, and conduct regular blood routine tests to find and deal with abnormal conditions in time.

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