成人和儿童过敏性紫癜的对比研究

Comparative study of Henoch-Scholein purpura in adults and children

目的 研究分析成人和儿童过敏性紫癜 (HSP)在临床及肾脏病理方面的不同特点以及影响HSP预后的危险因素。方法 对 15 6例HSP进行回顾性随访分析。患者发病年龄 <16岁为儿童组 ,≥ 16岁者为成人组 ,比较两组HSP在临床、肾脏病理和预后方面的差异 ,分析各种参数对HSP预后的影响程度。结果 成人和儿童HSP的发生均以男性较多见。成人因服用药物和食物诱发HSP者明显多于儿童组。临床上成人HSP肾脏受累 ,血沉和血清IgA升高的发生率明显比儿童组高。儿童HSP患者关节受累和呕吐者更多见。上呼吸道感染、发热、腹痛、黑便和肾病综合征的发生率两组差异无显著性。肾脏受累风险的增加与患者的发病年龄 [相对风险系数 (RR) =7 8],上呼吸道感染史 (RR =4 1)和腹痛病史 (RR =4 6 )密切相关。HSP肾脏的病理类型两组间差异无显著性 ,但成人肾小球外病变 (肾小管和间质病变 )的发生率明显高于儿童组。随访发现儿童HSP的完全缓解率 (76 7% )明显高于成人组 (45 2 % ) ,不全缓解者均表现为肾脏病变。临床蛋白尿和病理有肾小球外病变与HSP的预后密切相关 (RR分别为 5 3和 6 7)。结论 成人和儿童HSP在临床及肾脏病理上有明显不同的特点。成人HSP临床表现相对较重 ,肾脏受累多见 ,完全缓解率低。

Objective To assess the possible differences of the clinical features and renal pathology between children and adults with Henoch Schoelein purpura (HSP),and the contribution of clinical and renal biopsy parameters to predict the disease outcome.Methods A retrospective study was performed in 156 patients with HSP.Patients younger than 16 years at disease onset were considered children,and those aged 16 years or over were considered adults.Results The male was more prevalent in both adults and children HSP groups (M∶F=1 5∶1).The previous drug treatment,and special food intake were more frequent among the adults ( P =0 03 and 0 009,respectively).Renal involvement,increased ESR and serum IgA levels were more frequent in adults,but vomiting and joint pain were more in children.The frequencies of previous upper respiratory tract infection (URTI),fever,abdominal pain,melena and nephrotic syndrome were similar in both groups.Multivariate analysis showed that age at the disease onset,URTI and abdominal pain were predictive for renal involvement (RR=7 8,4 1 and 4 6,respectively).There were no differences of the renal pathologic types between two groups.However,lesions other than glomeruli including tubular and interstitial involvement were more frequent in adults.The outcome was better in children after a mean follow up of 6 2 years.Renal disease was the main clinical manifestation in non complete remission (NCR) patients.The proteinuria and the other area lesions out of glomeruli predict the decreased remission rate (RR=5 3 and 6 7,respectively).Conclusion These results indicate that HSP is more serious and nephritis is more frequent in adults.Proteinuria and lesions other than glomeruli are the higher risk factors of NCR.