过敏性紫癜合并免疫学异常的临床特点及预后  

The clinical manifestations and prognosis of Henoch-Schönlein purpura with immune abnormalities

作　　者：叶晓华[1] 杨康康[1] 上官瑶瑶 黄继谦[1] 郑雯洁[1] YE Xiaohua;YANG Kangkang;SHANGGUAN Yaoyao;HUANG Jiqian;ZHENG Wenjie(Department of Pediatric Rheumatology,the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院温州医科大学附属育英儿童医院儿童风湿科,浙江温州325000

出　　处：《中国现代医生》2023年第21期25-28,34,共5页China Modern Doctor

基　　金：温州市基础性科研项目(Y20190235)。

摘　　要：目的 探讨过敏性紫癜(Henoch-Sch?nlein purpura,HSP)合并抗链球菌溶血素O(antistreptolysin O,ASO)升高伴补体下降患者的临床特点及预后。方法 收集2009年1月至2015年6月在温州医科大学附属第二医院住院的HSP患者,根据有无免疫学异常分为四组:观察组(ASO升高合并补体下降)32例,随机选取高ASO组31例,低补体组32例,对照组(无上述免疫学异常)30例。比较四组患者的临床特点及预后。结果 观察组ASO水平高于高ASO组、补体4(complement4,C4)水平低于低补体组,差异有统计学意义(P<0.01)。观察组、高ASO组发病3个月内肾脏累及率高于对照组(P<0.05),低补体组与对照组比较,差异无统计学意义(P>0.05)。3个月内胃肠道及关节累及率和1年肾脏累及率在四组间无统计学差异。观察组中水肿2例,高血压3例,肾功能损害3例,均在2周内恢复正常;肉眼血尿3例,均在40d内消退;镜下血尿及蛋白尿持续中位时间10(4,510)d、10(4,78)d;ASO、补体3(complement3,C3)、C4水平恢复正常中位时间95(60,133)d、14(8,28)d、21(14,39)d;观察组血清白蛋白水平低于其余三组,血清球蛋白、免疫球蛋白(immunoglobulin,Ig)G、IgA水平均高于其余三组(P<0.05)。125例HSP患者中规律随访49例,平均随访时间(108.41±24.58)个月,最长随访155个月,随访期内均未出现慢性肾功能不全。结论 HSP合并ASO升高伴补体下降患者易早期出现肾脏累及,更易出现IgA、IgG升高及低白蛋白血症,补体均在100d内恢复正常,长期随访无一例出现慢性肾功能不全。Objective To analyze the clinical features of Henoch-Schönlein purpura(HSP)complicated with hypocomplementemia and elevated antistreptolysin O(ASO),to follow up and to evaluate the prognosis.Methods Patients with HSP admitted to the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2009 to June 2015 were collected and divided into 4 groups according to whether they had immunological abnormalities.32 cases were in observation group(increased ASO combined with decreased complement),31 cases were in high ASO group,32 cases in low complement group,and 30 cases in control group(without the above immunological abnormalities).The clinical characteristics and prognosis of the 4 groups were compared.Results The ASO level in observation group was higher than that in high ASO group,and complement 4(C4)level was lower than that in low complement group,with statistically significant differences(P<0.01).Observation group and high ASO group had a higher renal involvement rate within 3 months of onset compared to control group(P<0.05),while low complement group showed no significant difference compared to control group(P>0.05).There was no statistically significant difference in the rates of gastrointestinal and joint involvement within 3 months and renal involvement within 1 year among the 4 groups.In observation group,edema occurred in 2 cases,renal function impairment and hypertension each occurred in 3 cases,all of which returned to normal within 2 weeks;Gross hematuria occurred in 3 cases,all of which resolved within 40 days;The median duration of microscopic hematuria and proteinuria was 10(4,510)days and 10(4,78)days;The median time for ASO,complement 3(C3),and C4 levels to return to normal were 95(60,133)days,14(8,28)days,and 21(14,39)days;Observation group had lower serum albumin levels and higher serum globulin,immunoglobulin(Ig)G,and IgA levels compared to the other 3 groups(P<0.05).Among 125 HSP patients,49 patients were regularly followed up with an average follo

关 键 词：过敏性紫癜 低补体血症 抗链球菌溶血素O 紫癜性肾炎 

分 类 号：R593.2[医药卫生—内科学]