过敏性紫癜患儿的临床特征分析

Analysis of clinical features of children with allergic purpura

目的通过对儿童过敏性紫癜(HSP)临床结果的观察评估血液灌流(HP)治疗的近期及远期疗效。方法收集2014年1月至2018年12月期间在西安交通大学第一附属医院儿科诊断为HSP的患儿资料652例,其中首发267例,入院时随机分为非血液灌流组(NHP组,176例)和血液灌流组(HP组,91例)。观察两组患儿的近期及远期疗效指标,并进行统计分析。结果(1)652例HSP患儿平均年龄为(8.52±2.79)岁,男童(52.15%)多于女童(47.85%);好发于春季(34.20%)和冬季(28.07%),多发于农村地区(63.50%);29.45%的患儿发病前存在明显诱因,以呼吸道感染为主(79.17%),其次是食物过敏(14.58%);最常见的病原体为支原体(45.09%),首发临床症状以单纯皮肤症状最常见(34.36%)。(2)近期疗效显示:HP组患儿的皮疹消退时间、腹痛血便缓解时间、关节疼痛缓解时间均显著短于NHP组(t值分别为11.325、13.249、11.667,P<0.05),HP组患儿的平均住院日也显著短于NHP组(t=19.230,P<0.05)。(3)远期疗效显示:HP组患儿的皮疹复发率显著低于NHP组(χ^(2)=6.634,P<0.05);HP组患儿在随访期间进展为紫癜性肾炎(HSPN)的发生率低于NHP组,但差异无统计学意义(P>0.05)。结论(1)HSP患儿发病年龄多在610岁,以春冬季多发,男童多于女童,农村多于城区,最常见的诱因为感染,最常见的病原体为支原体,多以单纯皮肤紫癜为首发症状。(2)HP可在短时间内减轻HSP患儿的临床症状,减少平均住院日,远期观察可减少皮疹的复发率,但对远期肾脏损害的预防作用仍需进一步探讨。

Objective To observe clinical results of children with Henoch-Sch9 nlein purpura(HSP)and evaluate short-term and long-term curative effects of hemoperfusion(HP)therapy on HSP in children.Methods The clinical data of 652 children with HSP who were treated in Department of Pediatrics,The First Affiliated Hospital of Xi′an Jiaotong University over a period from January 2014 to December 2018 were collected and analyzed retrospectively.267 children were first diagnosed as HSP in our hospital,and they were randomly divided into non-hemoperfusion treatment group(176 patients,NHP group)and hemoperfusion treatment group(91 patients,HP group)at admission.Short-term and long-term efficacy indexes of the children in the two groups were observed and statistically analyzed.Results(1)The mean age of 652 HSP children was 8.52 years,and the ratio of boys:girls was 1.08∶1.00.Most of HSP occured in spring(34.20%)and winter(28.07%),and in rural areas(63.5%).29.45%of HSP children had inducing factors,among which the most common one was infection of respiratory tract(79.17%),and the next was food allergy(14.58%).The most common pathogen was mycoplasma(45.09%),and the initial clinical symptoms was usually simple skin changes(34.36%).(2)Observation of short-term efficacy:In the HP group,the disappearance time of skin rash,relief times of abdominal pain and blood stool and relief time of joint swelling pain were shorter than those in the NHP group(t=11.325,13.249 and 11.667 respectively,all P<0.05).The mean hospital stay of the children in the HP group was significantly shorter than that in the NHP group(t=19.230,P<0.05).(3)Observation of long-term efficacy:The recurrence rate of skin rash in the HP group was 30.8%,which was significantly lower than that in the NHP group(47.2%),the difference was statistically significant(χ^(2)=6.634,P<0.05).In the HP group,14.3%of the children developed into Henoch-Sch9 nlein purpura nephritis(HSPN),while in the NHP group,18.2%of the children developed into HSPN,but there was no statistically significant difference in incidence of HSPN between the two groups(P>0.05).Conclusion(1)The onset age of HSP is mostly among the age stages 6~10 years old,with frequent occurrence in spring and winter,more boys than girls,more rural areas than urban areas.The most common inducing factor is infection,the most common pathogen is mycoplasma,and the initial symptom is simple skin purpura.(2)HP can lessen clinical symptoms of these children with HSP within a short time,and shorten the mean hospital stay.Long-term observation shows that it can reduce the recurrence rate of skin rash,but its preventive effect on long-term renal injury still needs to be further investigated.