过敏性紫癜患儿复发的影响因素及IgE、IgA水平对其预测价值

Influencing factors of recurrence in children with Henoch Schonlein purpura and the predictive value of IgE and IgA levels

目的探讨影响过敏性紫癜(HSP)患儿预后因素,并分析血清总免疫球蛋白E(IgE)、总免疫球蛋白A(IgA)水平预测HSP复发的价值。方法选取2019年1月至2020年1月徐州市中心医院收治的HSP患儿95例,均为首次发病,并以随访复发结果为依据,分为HSP复发组(31例)和HSP未复组(64例)。比较两组总IgA、IgE水平变化,建立受试者工作特征(ROC)曲线分析总IgE、IgA水平预测HSP复发的效能,采用多因素Logistic回归分析对HSP复发进行危险因素分析。结果 HSP复发组家族史、呼吸道感染情况明显多于HSP未复组;HSP复发组预防用药、饮食控制、运动限制明显少于HSP未复组,差异有统计学意义(P<0.05)。入院时两组总IgA、IgE水平比较,差异无统计学意义(P>0.05);出院时HSP复发组总IgA、IgE水平均明显高于HSP未复组,差异有统计学意义(P<0.05)。ROC曲线分显示,出院时IgA、出院时IgE、联合预测复发的AUC分别为0.633、0.894、0.892,单独出院时IgE预测HSP复发准确性高,当取最佳截断值76.205 IU/mL时,其敏感度、特异度分别为100%、65.6%。对于HSP复发组,总IgA、IgE水平再次入院时与首次比较,差异无统计学意义(P>0.05);首次及再次出院时IgA水平比较,差异无统计学意义(P>0.05),相较于首次出院时,再次出院时IgE水平明显更高,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现,出院时高IgE水平、存在HSP家族史、发生呼吸道感染、未预防用药、未控制饮食、未限制运动均为HSP复发的独立性危险因素(P<0.05)。结论单独出院时IgE预测HSP复发准确性高,高IgE或可增加下次复发风险;HSP复发的危险因素众多,需进行针对性预防。

Objective To explore the factors affecting the prognosis of children with Henoch-Schonlein purpura(HSP),and to analyze the value of total IgE and IgA levels in predicting the recurrence of HSP. Methods Ninety-five children with HSP admitted to Xuzhou Central Hospital from January 2019 to January 2020 were selected for the first time. Based on the follow-up recurrence results,they were divided into the HSP recurrence group(31 cases)and the HSP non-recurrence group(64 cases). The changes in total IgA and IgE levels between the two groups were compared,the receiver operating characteristic(ROC)curves were established to analyze the efficacy of total IgE and IgA levels in predicting HSP recurrence,and multivariate logistic regression analysis was used to analyze the risk factors for HSP recurrence. Results The family history and respiratory infections in the HSP recurrence group were significantly more than those in the HSP non-recurrence group. The HSP recurrence group was significantly less prophylactic,diet control,and exercise restriction than the HSP non-recurrence group(P<0.05). There was no significant difference in the total IgA andIg E levels between the two groups at admission(P>0.05). The total Ig A and Ig E levels in the HSP recurrence group at discharge were significantly higher than those in the HSP non-recurrence group,the difference was statistically significant(P<0.05). The ROC curve scores showed that the AUCs of Ig A at discharge,Ig E at discharge,and combined prediction of recurrence were 0.633,0.894,and 0.892,respectively. Ig E at discharge alone had a high accuracy in predicting HSP recurrence. When the best cutoff value was 76.205 IU/ml,the sensitivity and specificity are 100% and 65.6% respectively. For the recurrence group,the total Ig A and Ig E levels were not statistically significant when compared to the first time when they were hospitalized again(P>0.05). There was no significant difference in Ig A levels between the first and second discharges(P>0.05).Compared with the first discharge,the Ig E levels were significantly higher when discharged again,and the difference was statistically significant(P<0.05). Multivariate logistic regression analysis found that high Ig E level at discharge,family history of HSP,occurrence of respiratory tract infection,no preventive medication,uncontrolled diet,and unrestricted exercise were independent risk factors for HSP recurrence(P<0.05).Conclusion Ig E predicts the recurrence of HSP with high accuracy when discharged from hospital alone,and high Ig E may increase the risk of next recurrence. There are many risk factors for HSP recurrence,and targeted prevention is required.