高原地区不同海拔高度腹型过敏性紫癜患者临床特征分析

doi:10.19723/j.issn.1671-167X.2021.06.011

摘要/Abstract

摘要：

目的:研究我国西藏高原地区不同海拔高度腹型过敏性紫癜(Henoch-Schonlein purpura, HSP)患者的临床特点。方法:选择西藏自治区人民医院2014年4月至2021年5月收治的190例腹型HSP患者的病例资料进行回顾性分析,根据发病前长期居住地海拔高度分为3组,对不同海拔患者的一般资料、临床特点、实验室检查数据、治疗及转归进行比较。结果:腹痛是腹型HSP患者最常见的临床表现,不同海拔地区的HSP患者在发病年龄、性别方面差异无统计学意义(P均>0.05)。高海拔地区过敏性紫癜患者更容易出现消化系统症状(P<0.01),海拔越高越容易合并肾受累或关节受累。高海拔地区腹型HSP患者的血小板为(512.1±55.0)×10⁹/L,C反应蛋白为11.2 (5.7, 19.4) g/L,显著高于于中海拔、较低海拔患者[分别为(498.3±76.9)×10⁹/L, 9.5 (4.6, 13.5) g/L和(456.4±81.2)×10⁹/L, 3.7 (0.2, 8.9) g/L]。HSP治疗有效率为98.9%,不同海拔地区患者治疗转归情况差异无统计学意义(P均>0.05)。多次住院的患者均合并肾受累且初始治疗未加用免疫抑制剂。结论:高原地区HSP并不少见,不同海拔水平发病年龄、性别差异不大,腹痛为最常见临床症状,长期居住于高海拔地区的患者更容易出现腹部症状且病情更严重,肾受累可能为预后不良的危险因素,早期应用激素联合免疫抑制剂可以有效控制病情并减少病情复发。

关键词: 高原, 过敏性紫癜, 腹部症状, 临床特征

Abstract:

Objective: To investigate the clinical characteristics of Henoch-Schonlein purpura (HSP) patients from different altitudes in Tibet plateau areas of China. Methods: A retrospective study was used to analyze the 190 HSP patients admitted to Tibet Autonomous Region People’s Hospital form April 2014 to May 2021. The subjects were divided into 3 groups according to the altitude of long-term residence before onset and the clinical data at different altitudes were compared and analyzed. Results: There were no significant differences in the age of onset and gender in HSP patients at different altitudes (P>0.05). The HSP patients in high altitude areas were more likely to have digestive symptoms (P<0.01). The patients were more likely to have kidney or joint involvement at higher altitudes. The platelets [(512.1±55.0)×10⁹/L] and C reactive protein [11.2 (5.7, 19.4) g/L] in high altitude areas were significantly higher than at medium altitudes [(498.3±76.9)×10⁹/L and 9.5 (4.6, 13.5) g/L] and lower altitudes [(456.4±81.2)×10⁹/L and 3.7 (0.2, 8.9) g/L] respectively. The effective rate of treatment was 98.9%, while there was no significant difference of outcome from different altitudes (P>0.05). The patients who were repeatedly hospitalized all had kidney involvement and no immunosuppressive agents were added in the initial treatment. Conclusion: HSP is common in high altitude areas. There was little difference in age of onset and gender at different altitudes. Abdominal pain was the most common clinical manifestation. Patients in high altitude areas were more likely to have severe abdominal problems. Kidney involvement may be poor prognostic factor. Early application of glucocorticoid combined with immunosuppressive agents can effectively control the disease and reduce the recurrence of HSP.

Key words: High altitude area, Henoch-Schonlein purpura (HSP), Abdominal manifestations, Clinical characteristics

中图分类号:

R593

魏慧,罗增,次旦央宗,白玛央金. 高原地区不同海拔高度腹型过敏性紫癜患者临床特征分析[J]. 北京大学学报（医学版）, 2021, 53(6): 1072-1077.

WEI Hui,Luo-zeng ##,Ci-dan-yang-zong ##,Bai-ma-yang-jin ##. Analysis of clinical characteristics of Henoch-Schonlein purpura patients from different altitudes in plateau areas[J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1072-1077.

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参考文献 20

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Projects	Lower altitude (n=33)	Medium altitude (n=74)	High altitude (n=83)	P
Male, n(%)	17 (51.5)	36(48.5)	56 (67.5)^a	0.785
Age/years, M (P₂₅, P₇₅)	22 (15, 34)	21 (16, 30)	17 (15, 31)	0.442
Stomachache, n(%)	32 (97.0)	74 (100.0)	81 (97.6)	0.369
Nausea, n(%)	0 (0)	17 (23.0)^b	56 (67.5)^ab	0.000
Vomiting, n(%)	0 (0)	10 (13.5)^b	41 (49.4)^ab	0.001
Gastrointestinal bleeding, n(%)	0 (0)	11 (14.9)^b	47 (56.6)^ab	0.005
Intestinal obstruction, n(%)	0 (0)	10 (13.5)^b	48 (57.8)^ab	0.007
Digestive tract perforation, n(%)	0 (0)	1 (1.4)	4 (4.8)	0.235
Kidney involvement, n(%)	4 (12.1)	17 (3.0)	60 (72.3)^ab	0.001
Joint involvement, n(%)	3 (9.1)	12 (16.2)	39 (47.0)^ab	0.003

Projects	Lower altitude (n=33)	Medium altitude (n=74)	High altitude (n=83)	P
HGB/(g/L), $\overline{x}$±s	152.6±31.5	157.2±28.9	143.7±40.8	0.324
Neutrophils/(10^9//L)	4.8±1.1	5.2±3.3	5.8±4.7	0.516
Eosinophils/(10^9//L)	0.02 (0.00-0.03)	0.01 (0.00-0.03)	0.02 (0.00-0.02)	0.712
Platelets/(10^9//L)	456.4±81.2	498.3±76.9	512.1±55.0^ab	0.041
CRP/(g/L)	3.7 (0.2-8.9)	9.5 (4.6-13.5)	11.2 (5.7-19.4)^ab	0.001
ESR/(mm/h)	6 (0-15)	14 (11-27)^b	17 (15-31)	0.073
D-dimer/(mg/L)	0.13 (0.11-0.74)	0.26 (0.24-0.75)	0.54 (0.49-0.98)	0.051
Albumin/(g/L)	31.2 (29.5-33.9)	30.7 (29.7-33.2)	27.6 (24.1-32.7)	0.062
IgG/(g/L)	18.5±3.2	18.7±2.3	19.0±3.9	0.798
IgA/(g/L)	6.9±1.2	6.8±1.7	7.3±2.9	0.893
IgM/(g/L)	1.4±0.6	1.6±0.3	1.2±1.1	0.887

Gastroscopy results	Lower altitude	Medium altitude	High altitude
Duodenal bulb, n(%)	5 (21.7)	4 (17.4)	3 (13.0)
Gastric antrum, n(%)	1 (4.3)	2 (8.7)	2 (8.7)
Gastric body, n(%)	0 (0)	1 (4.3)	2 (8.7)
Gastric fundus, n(%)	0 (0)	1 (4.3)	1 (4.3)
Gastric greater curvature, n(%)	0 (0)	0 (0)	1 (4.3)
Hyperemia	5	4	9
Edema	6	7	9
Erosion	4	3	3
Ulcer	4	7	7

Colonoscopy results	Lower altitude	Medium altitude	High altitude
Terminal ileum	1	2	1
Sigmoid colon	1	0	1
Descending colon	0	1	1
Transverse colon	0	0	1
Ascending colon	0	0	1
Rectum	0	1	0
Hyperemia	2	4	4
Edema	2	4	5
Bleeding	0	3	3
Ulcer	0	1	2

Treatment and outcome	Lower altitude (n=33)			Medium altitude (n=74)				High altitude (n=83)				P
Treatment and outcome	A	B		A		B		A		B		P
Symptomatic and supportive treatment	4 (12.1)		29(87.9)		17 (23.0)		57 (77.0)		60 (72.3)		23 (27.7)	-
Glucocorticoid	4 (12.1)		14 (42.4)		17 (23.0)		55 (74.3)		60 (72.3)^ab		17 (20.5)	0
Glucocorticoid combined immunosuppressant	2 (6.1)		1 (3.0)		17 (23.0)		24 (32.4)		60 (72.3)^ab		7 (8.4)	0
Immunoglobulin	0 (0)		0 (0)		6 (8.1)		6 (8.1)		26 (31.3)^ab		18 (21.7)	0
Recovered and discharged	4 (12.1)		29 (87.9)		17 (23.0)		57 (77.0)		60 (72.3)^ab		23 (27.7)	0.272
Died	0 (0)		0 (0)		0 (0)		0 (0)		2 (2.4)		0 (0)	0.148
Multiple hospitalizations	0 (0)		0 (0)		4 (5.4)		-		8 (9.6)		-	0.144