| 摘要: |
| 目的 探讨儿童过敏性紫癜（HSP）的发病情况及临床特点。方法 对我院在2012年6月至2014年7月收治的91例HSP患儿的临床表现、实验室指标进行分析，并与我国湖南省、西藏高原地区、武汉市以及印度尼西亚的研究结果进行对比。纳入同期来我院进行健康检查的87名健康儿童作为健康对照组，比较HSP患儿与健康对照儿童以及单纯皮肤、非肾脏混合和肾脏受累HSP患儿的免疫功能。结果 纳入研究的91例患儿男女比例为1.07∶1，平均年龄为（8.3±2.4）岁，>5岁且≤ 10岁年龄段是发病高峰，发病季节集中于10～12月；发病原因以呼吸道感染为主，34例（37.36%）的HSP患儿发病前2周内有明确呼吸道感染史。在临床表现方面，首发症状有皮疹损害者80例（88.89%），随后的整个病程中91例（100.00%）患儿均先后出现皮疹。首发症状有肾脏损害者12例（13.19%），随着病程发展增加到34例（37.36%），低于湖南省的发生率（χ2=19.194，P<0.01），但高于西藏高原地区和武汉市（χ2=3.591、12.319，P均<0.05）。>10岁且≤15岁患儿肾脏受累比例高于 > 5岁且≤10岁和 > 1岁且≤5岁两个年龄段[57.14%（16/28）vs 30.19%（16/53）、20.00%（2/10），χ2=5.570、4.077，P均<0.05]。出现各类伴随症状的时间平均约为7 d，肾功能异常出现最晚，平均约10 d。在免疫功能方面，HSP患儿CD4+T淋巴细胞比例及其与CD8+T淋巴细胞的比值均低于健康对照组（t=8.460、9.460，P均<0.01），但在HSP患儿单纯皮肤组、非肾脏混合组和肾脏受累组之间差异无统计学意义。HSP患儿IgG、IgA、IgE水平均高于健康对照组（t=7.841、13.933、6.870，P均<0.01），其中肾脏受累组的IgG和IgA水平均高于单纯皮肤组（t=4.941、5.111，P均<0.01）。结论 隐匿性感染对HSP发病的影响不容忽视。相比其他临床症状肾脏受累较为隐匿，疾病早期肾功能正常的患儿仍有必要较长时间动态监测尿常规。大多HSP患儿的免疫功能紊乱，主要表现为CD4+与CD8+T淋巴细胞比值下降，但与疾病的严重程度无明显相关性。 |
| 关键词: 过敏性紫癜 儿童 临床分析 免疫功能 肾脏损害 |
| DOI：10.16781/j.0258-879x.2018.05.0504 |
| 投稿时间：2017-09-05修订日期：2018-02-07 |
| 基金项目:上海市卫生和计划生育委员会青年基金（20134y194）. |
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| Clinical characteristics of children Henoch-Schönlein purpura: report of 91 cases |
| LEI Lei,ZHOU Lin,CAI Bin,GAN Lu,GAO Yu,JIANG Jin-jin* |
(Department of Pediatrics, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical characteristics and incidence of children Henoch-Schönlein purpura (HSP). Methods We retrospectively analyzed the clinical and laboratory characteristics of children with HSP in our hospital between Jun. 2012 and Jul. 2014, and compared the results with Hunan province, plateau area of Tibet, and Wuhan city in China and Indonesia. Eighty-seven healthy children, who received physical examination in our hospital during the same period, were recruited as healthy control group. The immune functions were compared between the HSP patients (skin involvement, non-renal damage and renal damage) and healthy children. Results The ratio of male to female was 1.07:1 in the 91 HSP patients aged (8.3±2.4) years old. The age of >5 and ≤ 10 years old had the peak morbidity, and the morbidity time concentrated between October and December. The main cause of HSP was respiratory tract infection, and 34 cases (37.36%)had a history of respiratory tract infection within 2 weeks before onset. In clinical manifestations, 80 cases (88.89%) had rash and 12 (13.19%) had renal involvement at the first stage. During the whole course of disease, all 91 (100.00%) children suffered from rash, and 34 (37.36%) children had renal involvement. The incidence of renal involvement was significantly lower versus the incidence in Hunan province (χ2=19.194, P<0.01), and was significantly higher versus the incidence in plateau area of Tibet and Wuhan city (χ2=3.591, 12.319; both P<0.05). The incidence of renal involvement was significantly higher in the children aged > 10 and ≤ 15 years than that in the children aged > 5 and ≤ 10, and > 1 and ≤ 5 years (χ2=5.570, 4.077; both P<0.05). The mean onset time of accompanying symptoms was on about 7 days, and the latest symptom was abnormality of renal function, with an average of about 10 d. In immunologic function, the proportion of CD4+ T lymphocytes and the ratio of CD4+ to CD8+ T lymphocytes were significantly lower in the HSP group than those in the healthy control group (t=8.460, 9.460; both P<0.01), while no significant differences were found between the skin, non-renal damage or renal damage groups. The levels of IgG, IgA and IgE were significantly higher in the HSP group than those in the healthy control group (t=7.841, 13.933, 6.870; all P<0.01). The levels of IgG and IgA were significantly higher in the renal damage group than those in the skin group (t=4.941, 5.111; both P<0.01). Conclusion Occult infection should be emphasized in the incidence of HSP. Renal involvement is always imperceptible, and long time dynamic monitoring of urine routine is very important at early stage of HSP. The imbalance of immunologic function plays an important role in the HSP, especially in the reducing ratio of CD4+ to CD8+ T lymphocytes, but has no correlation with the severity of the disease. |
| Key words: Henoch-Schönlein purpura child clinical manifestation immune function renal damage |
