儿童过敏性紫癜病138例临床分析

Clinical characteristics analysis of 138 cases of Henoch-Schonlein purpura

目的：探讨过敏性紫癜（ HPS）的临床特征与肾损害的高危因素。方法收集第四军医大学附属唐都医院自2013年1月至2014年6月收治的138例过敏性紫癜患儿的临床资料，并对其进行6个月以上的随访。结果①5～9岁为发病年龄高峰，占73．18％，冬、春、秋季多发；②感染是主要发病原因，66．6％的患儿有感染或前驱感染病史；③胃肠道、肾损害及关节症状发生率分别是49．28％、31．88％、47．10％；④年龄偏大儿童、腹痛、消化道出血为肾脏损伤的相关危险因素（ OR值分别为1．252、2．846、2．369，均P＜0．05）；⑤重症HSP应用糖皮质激素并未显示预防紫癜复发及肾脏损害的效果。结论 HSP多好发于5～9岁儿童，感染是发病的主要诱因，对于其他系统症状明显者，需仔细查体。对具有肾损害高危因素的患儿须定期随访。重症HSP应用糖皮质激素能否预防HSP复发及肾损害，有待于进一步研究。

Objective To study the clinical characteristics of Henoch-Schonlein purpura （HSP） and high risk factors of kidney damage. Methods From January 2013 to June 2014 138 cases of HSP were collected in Tangdu Hospital of Fourth Military University, and all patients were followed up for at least 6 months. Results The peak age of incidence was 5 -9 years old （73.18%）, and HSP was more common in winter, spring and autumn. Infection was the main etiology, and 66.6% of HSP children were associated with infection or precursor infection. The incidence rates of gastrointestinal symptoms, kidney damage and joint symptoms were 49.28%, 31.88% and 47.10%, respectively. Older children, abdomen pain and gastrointestinal bleeding were the main risk factors of renal damage （OR value was 1. 252, 2. 846 and 2.369, respectively, all P 〈 0.05）. The use of glucocorticoid for patients with severe allergic purpurahas had no obvious effect on prevention of relapses and renal damage. Conclusion HSP appears mostly in children aged 5 - 9 years old, and infection serves as the chief incentive for HSP. If other systems are severe, it is necessary to perform examination carefully. Regular follow-up should be conducted for high risk children with renal damage. Whether the use of glucocorticoid for severe HSP is effective in preventing relapse and renal damage needs further researches.