儿童过敏性紫癜575例分析

Clinical analysis of 575 cases with henoch-schnlein purpura

目的 探讨儿童过敏性紫癜 (HSP)的临床特点。方法 对 1996年 1月 1日～ 2 0 0 0年 12月 31日 ,在本院住院的 5 75例过敏性紫癜患儿的发病特点、临床表现、肾损害相关因素及预后等方面进行回顾性分析。结果 (1) 1996～ 2 0 0 0年 ,每年的患病率依次为 0 4 3%、0 6 0 %、0 75 %、0 78%及1 2 1%。 (2 )农村患儿 386例 ,占 6 7 13%。 (3)诱因 :感染 337例 ,占 5 8 6 1% ,进食特殊食物 12 8例 ,占2 2 2 6 %。 (4)出现肾脏症状 2 72例 ,发生率为 4 7 30 %。 118例皮肤紫癜者 2 5例出现肾脏损害 ,占2 1 19% ;114例皮肤紫癜加关节症状者 ,34例出现肾脏损害者 ,占 2 9 82 % ;192例皮肤紫癜加消化道症状者中 119例发生肾损害 ,占 6 1 98% ;15 1例皮肤紫癜加消化道症状加关节症状者中 94例发生肾损害 ,占 6 2 2 5 % (P <0 0 0 5 )。 (5 )预后 :5 4 3例治愈好转 ,占 94 4 8%。 9例血C3 减低者中 3例分别在1～ 2年后出现典型的SLE表现。结论 (1)HSP患病率有逐年升高趋势。农村患儿发病较多。发病诱因仍以感染为第一位。 (2 )HSP早期出现较多肾外症状 ,特别是消化道症状明显者 ,易发生肾脏损害。 (3)HSP中出现血C3 减低者 ,其早期“紫癜样皮疹”有可能为SLE的皮肤损害之一 ;紫癜肾伴血C3减低者 ,应及早?

Objective To study the clinical characteristics of Henoch Schnlein purpura (HSP). Methods The 575 cases with HSP treated from January 1, 1996 to December 31, 2000 were retrospectively studied and patterns of onset, clinical manifestations, correlated factors of renal damage and outcomes were analysed. Results (1) The morbidity of HSP was 0.43%, 0.60%, 0.75%, 0.78% and 1.21% from 1996 to 2000, respectively. (2) Of the 575 cases, 386 (67.13%) were rural children. (3) Inducing factors: The inducing factors were infections (377 cases, 58.61%), special food (128 cases, 22.26%) and vaccinations (7 cases,1 22%). (4) There were two important initial symptoms including skin purpura (380 cases, 66.09%) and abdominal pain (73 cases, 12.70%). (5) Totally 272 cases (47.30%) presented symptoms of renal damage. The duration between presenting purpura and renal symptoms was ～1 week (124 cases, 45.59%), ～2 weeks (63 cases, 23.16%), ～3 weeks (29cases, 10.66%), ～4 weeks (30 cases, 11.03%). The percentages of patients presenting renal damage were 21.19%, 29.82%, 61.98% and 62.25% for the patients with purpura only, with purpura and joint symptoms, with purpura and gastrointestinal tract symptoms, and with all the above symptoms, respectively ( P <0.005). (6) Outcomes: 543 cases were cured or greatly improved; in 3 of the 9 cases with low complement C3 level, systemic lupus erythematosus (SLE) occurred during the following 1 2 years. Conclusions (1) Morbidity of HSP increased year by year. The most important inducing factor was infection. Owing to poor skin hygiene and some allergen in the environment, morbidity was high in the rural children. (2) It is not urgent to do explorative operation if abdominal pain was the initial symptom. (3) There were many extrarenal symptoms during early phase in the HSP patients. Those with obvious gastrointestinal symptoms tended to have renal damage. (4) The eruption like purpura of the HSP patients with low comlement C3 level may be the skin damage of SLE. To differentiate from SLE, renal biopsy should be performed early for HSP nephritis patients with low complement C3 level.