初发过敏性紫癜患儿肾脏受累危险因素分析  

Follow-up study of risk factors of renal involvement in children with new-onsetHenoch Schnlein purpura

作　　者：奚晓隽[1] 鲍华英[1] 黄松明[1] 张爱华[1] 陈颖[1] 韩媛[1] 

机构地区：[1]南京医科大学附属南京儿童医院肾脏科,南京210008

出　　处：《中国循证儿科杂志》2011年第5期349-353,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的对初发过敏性紫癜(HSP)患儿进行随访,探讨HSP患儿肾脏受累的危险因素。方法前瞻性纳入2009年12月至2010年11月在南京医科大学附属南京儿童医院肾脏科住院的初发HSP患儿,随访6个月,根据肾脏受累定义,将HSP患儿分为肾脏受累组和无肾脏受累组。复习文献提取与肾脏受累可能相关的3项人口学特征、8项临床症状和17项辅助检查指标进行分析,先行单因素分析,对有统计学意义的变量行Logistic回归分析。结果研究期间共纳入初发HSP患儿283例,平均发病年龄为(7.2±2.6)岁(8月龄至16岁)。239/283例(84.5%)完成随访。283例初发HSP患儿均有紫癜样皮疹表现,分别有194/283例(68.6%)和224/283例(79.2%)患儿有消化道和关节症状。80/239例(33.5%)患儿在随访过程中出现肾脏受累,以孤立性蛋白尿为主(44/80例,55.0%)。发病1个月内出现肾脏受累者占50.0%(40/80例),3个月内出现肾脏受累者占88.8%(71/80例)。单因素分析提示年龄≥8岁、皮疹反复、皮疹持续≥2周、无菌性白细胞尿、血清白蛋白、血小板平均容积(MPV)≥10fL、胱抑素C(CysC)≥0.8mg·L-1和血清C3≤0.88g.L-1在肾脏受累组和无肾脏受累组间差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,无菌性白细胞尿:OR=4.178,95%CI:2.061～8.468,皮疹持续≥2周:OR=2.474,95%CI:1.367～4.478,MPV≥10fL:OR=2.948,95%CI:1.533～5.667,CysC≥0.8mg·L-1:OR=2.101,95%CI:1.067～4.134。结论无菌性白细胞尿、皮疹持续≥2周、MPV≥10fL和CysC≥0.8mg·L-1为初发HSP患儿肾脏受累的独立危险因素。Objective To identify the risk factors for renal involvement among pediatric patients with new-onset Henoch Schnlein purpura（HSP）.Methods Consecutive patients with new-onset HSP hospitalized in Nanjing Children＇s Hospital of Nanjing Medical University from December 2009 to November 2010,were recruited and followed up for 6 months since the onset of HSP and were classified by the condition of renal involvement.Gender,age,possible risk factors of renal involvement were analyzed by univariate and multivariate Logistic regression analysis.Results A total of 283 new-onset HSP children were included during the follow-up period and the mean age was 7.2±2.6 years（8 months to 16 years）,among 239 patients（84.5%） finished the study,the rate of losing follow-up was 15.5%（44/283 cases）.Palpable purpura was observed in all of the new-onset HSP children,whereas gastrointestinal symptoms and transient arthritis were found in 194（68.6%） and 224（79.2%） children,respectively.Renal involvement was seen in 80 patients（33.5%） and 44 of them（55.0%） were isolated proteinuria.In univariate analysis,≥8 years at onset,persistent purpura（more than 2 weeks）,purpura recurrence,higher level of mean platelet and cystatin C,lower level of serum C3 and albumin,aseptic leucocyturia were identified as risk factors to the outcome.Multivariate logistic regression analysis showed that nephritis was significantly associated with persistent purpura more than 2 weeks（OR=2.474,95%CI：1.367-4.478）,aseptic leucocyturia（OR=4.178,95%CI：2.061-8.468）,higher level of mean platelet volume more than 10 fL（OR=2.948,95%CI：1.533-5.667） and cystatin C more than 0.8 mg·L^-1（OR=2.101,95%CI：1.067-4.134）.Conclusions Persistent purpura（more than 2 weeks）,aseptic leucocyturia,higher level of mean platelet volume（more than 10 fL） and cystatin C（more than 0.8 mg·L^-1） were identified as the risk factors for renal involvement in children with HSP.

关 键 词：过敏性紫癜 肾脏受累 儿童 随访 危险因素 

分 类 号：R726.9[医药卫生—儿科]