儿童过敏性紫癜复发及肾脏损伤的相关因素分析

Analysis of the clinical factors associated with recurrence and renal injury in children with Henoch-Schönlein purpura

目的探讨儿童过敏性紫癜(HSP)复发及肾脏损伤的临床相关因素。方法选取2020年1月至2021年12月于张家界市人民医院儿科住院的136例HSP患儿作为研究对象,根据复发情况分为复发组(n=59)与非复发组(n=77),根据肾脏损伤情况分为肾脏损伤组(n=41)与非肾脏损伤组(n=95),对复发组与非复发组、肾脏损伤组与非肾脏损伤组人口学因素、临床表现、实验室指标进行单因素和多因素Logis-tic分析。结果复发组年龄、总胆固醇(TC)、甘油三酯(TG)水平及年龄≥6岁、皮疹持续时间≥2周比例高于非复发组,差异有统计学意义(P<0.05)。肾脏损伤组年龄、肌酐(Cr)水平及年龄≥6岁、病原学检查阳性比例高于非肾脏损伤组,红细胞沉降率(ESR)水平及前驱呼吸道感染史、ESR异常比例低于非肾脏损伤组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,皮疹持续时间≥2周(OR=6.243,P=0.008)及TG水平升高(OR=2.951,P=0.046)是HSP复发的独立危险因素,前驱呼吸道感染史(OR=0.271,P=0.005)及ESR异常(OR=0.189,P=0.045)均为HSP肾脏损伤的保护因素。结论皮疹持续时间≥2周、TG水平升高是HSP复发的独立危险因素,前驱呼吸道感染史、ESR异常为HSP肾脏损伤的保护因素,临床中应基于上述影响因素进行相应判别,加强监测与长期随访。

Objective To investigate the clinical factors associated with recurrence and renal injury in children with Henoch-Schönlein purpura(HSP).Methods A total of 136 children hospitalized with HSP from January 2020 to December 2021 in the department of pediatrics in Zhangjiajie City People's Hospital were collected as the research subjects,they were divided into the recurrence group(n=59)and non-recurrence group(n=77)according to the recurrence situation,and the renal injury group(n=41)and non-renal injury group(n=95)according to the kidney injury situation.The demographic factors,clinical manifestations and laboratory indicators between the different groups were treated by univariate and multivariate Logistic regression analysis.Results The age,total cholesterol(TC)level,triglyceride(TG)level,the proportion of age≥6 years old and the dura-tion of skin rash≥2 weeks in the recurrence group were higher than those in the non-recurrent group,and the differences were statistically significant(P<0.05).The age,creatinine(Cr)level,the proportion of age≥6 years old and etiological examination positivein the renal injury group were higher than those inthe non-renal injury group.While,the erythrocyte sedimentation rate(ESR)level,the proportion of prodromal respiratory infection-sand abnormal ESR in the renal injury group were lower than those in the non-renal injury group.These differences above were statistically signifi-cant(P<0.05).Multivariate Logistic regression analysis showed that the duration of skin rash≥2 weeks(OR=6.243,P=0.008)and the increase of TG level(OR=2.951,P=0.046)were independent risk factors of recurrence with HSP,and the prodromal respiratory infections(OR=0.271,P=0.005)and the abnormal ESR(OR=0.189,P=0.045)were protective factors of renal injury with HSP.Conclusion The duration of skin rash≥2 weeks and the increase of TG level were independent risk factors of recurrence with HSP,while the prodromal respiratory infections and the abnormal ESR were protective factors of renal injury with HSP,we should make corresponding judgment based on the above influencing factors in clinical practice,and strengthen monitoring and long-term follow-up.