儿童过敏性紫癜并心脏损害的临床特点及危险因素

Clinical characters and risk factors for Henoch - Schonlein Purpura combined with cardiac damage in children

目的：探讨儿童过敏性紫癜（HSP）合并心脏损害的临床特点及危险因素。方法对南京市儿童医院2011年11月至2012年12月收治的707例住院 HSP 患儿的临床及实验室资料进行回顾性分析，同时记录 HSP 合并心脏损害可能的相关危险因素，包括性别、年龄、发病前存在诱因、腹痛、关节痛、肾损害情况、血电解质、抗“O”、红细胞沉降率、类风湿因子、补体水平等。采用 Pearson χ2检验及二元 Logistic 回归分析探讨 HSP患儿合并心脏损害的危险因素。结果 HSP 合并心脏损害的有192例，占总病例27.2％，其中男115例，女77例，男女比例为1.00：0.67；年龄11个月~15岁4个月（中位年龄6岁5个月），﹤3岁6例（3.1％），≥3~7岁103例（53.7％），≥7~14岁82例（42.7％），≥14岁1例（0.5％），发病年龄多在学龄前期及学龄期。192例患儿中有190例存在心电图异常，主要表现为 Q-T 间期延长、ST-T 改变及窦性心动过缓；24例存在1项或多项心肌酶异常；35例患儿行超声心动图检查，均无心内结构异常改变；患儿均未述明显胸闷、心慌或心前区不适等症状。χ2检验显示：患儿性别、发病前存在诱因、临床表现为混合型 HSP、伴低补体血症与 HSP 合并心脏损害有关（P ﹤0.05）；二元 Logistic 回归分析显示，男性患儿（X1）的比值比（OR）值为0.654（95％ CI 0.462~0.926，P ﹤0.05），有无发病诱因（X2）的 OR 值为2.63（95％ CI 1.838~3.765，P ﹤0.001），临床表现为混合型HSP（X3）的 OR 值为2.452（95％ CI 1.301~4.621，P ﹤0.01）。结论 HSP 合并心脏损害的特征主要为心电图和/或心肌酶谱异常。对男性患儿、发病前存在呼吸道感染等诱因、临床表现为混合型 HSP、有低补体血症者应予高度重视，尽早行心电图、心肌酶等相关检查，并早期进行诊治，避免重症病例的发生。

Objective To summarize the clinical characteristics and laboratory test results of children with Henoch - Schonlein purpura（HSP）,and further to analyze the risk factors for HSP combined with cardiac damage. Methods The clinical and laboratory tests findings from 707 children diagnosed as HSP at Nanjing Children＆#39;s Hospi-tal were retrospectively analyzed,who were recruited from November 2011 to December 2012. The possible risk factors for HSP with cardiac damage in children were recorded,including gender,age,predisposing causes,gastrointestinal symptoms,joint pain,kidney disorders,serum electrolytes,anti - streptolysin 〝O〝 test,erythrocyte sedimentation rate, and complement level were summarized. Chi - square test and Logistic regression were performed to analyze the risk fac-tors of cardiac damage in children with HSP. Results Among 707 cases,192（27. 2% ）patients were combined with car-diac damage,115 male and 77 female,and the proportion of men to women was 1. 00： 0. 67;age ranged from 11 months to 15 years and 4 months（6 years and 5 months for median age）,6 patients ﹤ 3 years old occupying 3. 1% ,103 patients≥3 - 7 years old occupying 53. 7% ,82 patients≥7 - 14 years old occupying 42. 7% ,1 patient≥14 years old occupying 0. 5% ,and the age of onset in preschool and school age. Electrocardiogram（ECG）abnormalities were found in 190 patients,the main manifestations including long Q - T interval,ST - T segment falling down and sinus bradycar-dia,and one or more items of abnormal myocardial enzymes existed in 24 cases;echocardiography was performed in 35 cases of children,but no abnormality was detected,no obvious symptoms such as flustered or chest tightness or precor-dial distress. Statistical analysis showed that gender,predisposing causes,mixed HSP,complement level were related to the incidence of cardiac damage in children with HSP（P ﹤ 0. 05）. Furthermore binary Logistic regression identified that in male patients,the ratio of X1 vs OR ratio was 0. 654（95% CI 0. 462 - 0. 926,P ﹤ 0. 05）,for predisposing causes,the ratio of X2 vs OR ratio was 2. 63（95% CI 1. 838 - 3. 765,P ﹤ 0. 001）,for mixed HSP,the ratio of X3 vs OR ratio was 2. 452（95% CI 1. 301 - 4. 621,P ﹤ 0. 01）,which were independent factors for cardiac damage in chil-dren with HSP. Conclusions ECG and/ or myocardial enzyme spectrum abnormalities are the main clinical ma-nifestations of cardiac damage in children with HSP. Male patients,predisposing causes of the respiratory tract infec-tion,mixed HSP and hypocomplementemia were high risk factors in the development of cardiac damage,which require special consideration clinically,and earlier ECG and myocardial enzymes examination,early diagnosis and treatment are necessary to avoid the occurrence of severe cases.