469例儿童过敏性紫癜临床分析

Clinical analysis of 469 cases of Henoch-Schonlein purpura in children

目的了解过敏性紫癜(HSP)的流行病学特征,研究HSP各表型的特点及紫癜性肾炎的危险因素。方法对2010-2016年在苏州大学附属第三医院(常州市第一人民医院)确诊为HSP的住院患儿的临床资料及辅助检查结果进行回顾性分析。结果 HSP起病年龄为2~13岁,秋冬季发病为主,前驱感染者是主要诱因;患儿以皮肤紫癜为首发症状94.0%(441/469);关节不适12例(2.6%),腹部症状16例(3.4%),HSP复发患儿12.3%(58/469),其中过敏性紫癜性肾炎(HSPN)2.6%(12/469);所有患儿均为抗中性粒细胞胞浆抗体(ANCA)阴性,总IgE阳性率50.7%(238/469);腹型HSP患儿白细胞及D-二聚体增高是消化道出血的危险因素;年龄、D-二聚体、胱抑素C(CysC)为紫癜性肾炎的独立危险因素,混合型HSP较其他类型更易发生肾损害。结论 HSP患儿皮疹易复发,尤其多发生于肾损害患儿;腹型HSP中白细胞、D-二聚体升高可能提示消化道出血;临床症状及辅助检查出现相关异常时,需警惕HSPN的发生;HSP为自限性疾病,多预后良好。

Objective To investigate the epidemiological characteristics of Henoch-Schonlein purpura （HSP） and to study the characteristics of each phenotype and risk factors of HSPN. Methods The HSP patients from 2010 to 2016 were enrolled in the Third Affiliated Hospital of Soochow University and the clinical data were analyzed retrospectively.Results The onset age of HSP was 2 years-13 years old, mainly in autumn and winter.The precursor infection was one of the commonest causes; as the first symptom, skin purpura accounted for 94.0%（441/469）, joint discomfort as the first symptom accounted for 2.6%（12/439）,3.4%（16/469） were abdominal symptoms; HSPN recurrence accouted for 12.3%（58/469）, of which HSPN group of 2.6%（12/469）; ANCA was negative in all of children and the total IgE positive rate was 50.7%（238/469）. The increase of WBC and D-dimer were the risk of gastrointestinal bleeding. The multivariate analysis showed that age, D-dimer, CysC,malb increased the risk of renal involvement.Conclusion HSP children rash easy to relapse, especially in HenochSchonlein purpura nephritis patients.The increase of WBC and D-dimer may indicate increased the risk of gastrointestinal bleeding.The age, two D-dimer, serum CysC, microalbuminuria was correlated with the incidence of HSPN.Thus,we should be aware of the occurrence of HSPN when examining abnormalities.Henoch-Schonlein purpura is generally a benign disease, as a selflimiting disease with good prognosis.