儿童过敏性紫癜临床特征分析(附184例报道)

Clinical Features of Henoch Schnlein Purpura in Children: a Report of 184 Cases

摘要:

目的 了解过敏性紫癜儿童的临床特征。方法：回顾性分析过敏性紫癜患儿184例，对其临床表现及特征进行分析。结果：①发病年龄均>2岁，平均发病年龄(7.8±2.6)岁；67.4%患儿于秋冬季节发病；62.5%患儿有明确诱因，以上呼吸道感染为主。②所有病人均有典型皮肤紫癜，分布于下肢(100%)、臀部(47.3%)、上肢(17.4%)等。89.1%患儿以皮肤紫癜首发，少数以胃肠道及关节症状为首发症状后2周内出疹，先出现肾脏损害而后出疹者罕见。胃肠道及关节症状发生率分别为60.9%和44.6%。紫癜性肾炎发生率为52.2%，临床上主要表现为血尿和(或)蛋白尿(68.8%)，病理改变主要为Ⅰ～Ⅲ级(85.2%)。③44.0%病人血沉增快，24.1% ASO增高；63.7%病人IgA增高，IgG，IgM及补体绝大多数正常。结论：过敏性紫癜为儿童常见病，且有其本身临床特征及发病规律。

Abstract:

OBJECTIVE: To study the clinical features of Henoch Schonlein purpura (HSP) in Chinese children. METHODS: The clinical features of 184 children with HSP were analyzed retrospectively. RESULTS: ① The age of onset of all the 184 children with HSP was over two years and the mean age was ( 7.8 ± 2.6 ) years. Of the 184 children, 67.4% developed HSP during the fall and winter months; 62.5% of the HSP patients revealed evident predisposing factors, mainly upper respiratory infection. ② Of all the patients, 89.1% had typical purpura as the presenting cutaneous sign. The distribution of rash in the lower extremities, buttock and upper extremities was 100%, 47.3% and 17.4% , respectively. Gastrointestinal involvement and arthritis occurred in 60.9% and 44.6% , respectively. Of all the patients, 52.2% developed HSP nephritis manifested as isolated hematuria and/or proteinuria ( 68.8% ) and the main pathological types were grade Ⅰ～Ⅲ ( 85.2% ). ③ Erythrocyte sedimentation increased in 44.0% of the patients; Antistreptolysin O titers (ASOT) and levels of immunoglobulin A (IgA) increased in 24.1% and 63.7% of the cases, respectively. The levels of immunoglobulin G (IgG), immunoglobulin M (IgM) and complements were normal in most patients. CONCLUSIONS: HSP in children has its own clinical and episodic features.