儿童过敏性紫癜临床特征分析(附184例报道)

Clinical Features of Henoch-Schnlein Purpura in Children: a Report of 184 Cases

目的 了解过敏性紫癜儿童的临床特征。方法 回顾性分析过敏性紫癜患儿 184例 ,对其临床表现及特征进行分析。结果 ①发病年龄均 >2岁 ,平均发病年龄 (7.8± 2 .6 )岁 ;6 7.4 %患儿于秋冬季节发病 ;6 2 .5 %患儿有明确诱因 ,以上呼吸道感染为主。②所有病人均有典型皮肤紫癜 ,分布于下肢 (10 0 % )、臀部(47.3% )、上肢 (17.4 % )等。 89.1%患儿以皮肤紫癜首发 ,少数以胃肠道及关节症状为首发症状后 2周内出疹 ,先出现肾脏损害而后出疹者罕见。胃肠道及关节症状发生率分别为 6 0 .9%和 4 4 .6 %。紫癜性肾炎发生率为 5 2 .2 % ,临床上主要表现为血尿和 (或 )蛋白尿 (6 8.8% ) ,病理改变主要为Ⅰ～Ⅲ级 (85 .2 % )。③ 4 4 .0 %病人血沉增快 ,2 4 .1%ASO增高 ;6 3.7%病人IgA增高 ,IgG ,IgM及补体绝大多数正常。 结论 过敏性紫癜为儿童常见病 。

Objective To study the clinical features of Henoch Schonlein purpura (HSP) in Chinese children. Methods The clinical features of 184 children with HSP were analyzed retrospectively. Results ① The age of onset of all the 184 children with HSP was over two years and the mean age was ( 7.8 ± 2.6 ) years. Of the 184 children, 67.4% developed HSP during the fall and winter months; 62.5% of the HSP patients revealed evident predisposing factors, mainly upper respiratory infection. ② Of all the patients, 89.1% had typical purpura as the presenting cutaneous sign. The distribution of rash in the lower extremities, buttock and upper extremities was 100%, 47.3% and 17.4% , respectively. Gastrointestinal involvement and arthritis occurred in 60.9% and 44.6% , respectively. Of all the patients, 52.2% developed HSP nephritis manifested as isolated hematuria and/or proteinuria ( 68.8% ) and the main pathological types were grade Ⅰ～Ⅲ ( 85.2% ). ③ Erythrocyte sedimentation increased in 44.0% of the patients; Antistreptolysin O titers (ASOT) and levels of immunoglobulin A (IgA) increased in 24.1% and 63.7% of the cases, respectively. The levels of immunoglobulin G (IgG), immunoglobulin M (IgM) and complements were normal in most patients. Conclusions HSP in children has its own clinical and episodic features.