儿童过敏性紫癜287例临床分析

Clinical analysis of 287 cases with Henoch-Schonlei¨n Purpura in children

目的:探讨儿童过敏性紫癜 (HSP)的临床特征。方法 :对 2 87例过敏性紫癜患儿的发病特点、临床表现及肾损害相关因素等方面进行回顾性分析。 结果 :(1)平均发病年龄 (8.75± 3.0 9)岁 ,以上呼吸道感染为诱因者占4 3.5 5 %。 (2 )紫癜性肾炎的发生率为 35 .5 4 % ,男女之比为 1.4 9∶ 1。皮肤紫癜反复在非肾损组占 2 3.78% ,而在肾损组占 5 5 .88% (P <0 .0 0 1)。皮肤紫癜伴有消化道症状者的肾损害发生率明显高于单纯皮肤紫癜者 (P <0 .0 0 5 )。 (3)血小板计数增高占 4 6 .6 9% ,血沉增快占 2 9.87% ,血浆纤维蛋白原增高占 15 .74 %。 结论:(1) HSP发病诱因以感染占第一位。 (2 )男性更易发生肾损害。皮肤紫癜反复或合并消化道症状明显者肾脏更易受累及。 (3)HSP患儿存在高粘滞血症 ,有必要早期应用改善微循环药物。

Objective: To study the clinical characteristics of Henoch-Schonlei¨n Purpura (HSP). Methods: The 287 cases with HSP were retrospectively studied and patterns of onset, clinical manifestations and correlated factors of renal damage were analyzed. Result: (1) The mean age of onset was (8.75±3.09) years. 52.96% of the patients revealed evident predisposing factors,mainly upper respiratory infection. (2) Totally 102 cases (35.54%) developed HSP nephritis, and the ratio of boys′ and girls′, was 1.49∶1. The recurrent of skin purpura was 55.88% and 23.78% for the patients with renal damage or not, respectively. The patients with purpura and gastrointestinal tract symptoms presented more renal damage than those with purpura only. (3) Platelet count,Erythrocyte sedimentation rate (ESR) and level of fibrinogen (FIB) increased in 46.69%, 29.87% and 15.74% of the cases,respectively. Conclusion: (1) The most important inducing factor of HSP was infection. (2) Boys had more often renal damage than girls. Those with recurrent skin purpura or obvious gastrointestinal symptoms tended to have renal damage. (3) The patients were in the hypercoagulatory state,and early anticoagulation therapy was necessary.