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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (5): 923-928. doi: 10.19723/j.issn.1671-167X.2023.05.022

• 论著 • 上一篇    下一篇

高原地区不同类型过敏性紫癜藏族患者发病的相关危险因素

魏慧1,次旦央宗2,益西拉姆2,白玛央金2,*()   

  1. 1. 北京大学第三医院风湿免疫科, 北京 100191
    2. 西藏自治区人民医院风湿免疫血液内科, 拉萨 850000
  • 收稿日期:2022-08-02 出版日期:2023-10-18 发布日期:2023-10-09
  • 通讯作者: 白玛央金 E-mail:13518986955@163.com
  • 基金资助:
    西藏自然科学基金(XZ2021ZR-ZY06(Z))

Risk factors associated with different types of Henoch-Schönlein purpura in Tibetan patients at high altitude

Hui WEI1, Ci-dan-yang-zong2, Yi-xi-la-mu2, Bai-ma-yang-jin2,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Rheumatology, Immunology and Hematology, Tibet Autonomous Region People's Hospital, Lhasa 850000, China
  • Received:2022-08-02 Online:2023-10-18 Published:2023-10-09
  • Contact: Bai-ma-yang-jin E-mail:13518986955@163.com
  • Supported by:
    the Natural Science Foundation of Tibet Autonomous Region(XZ2021ZR-ZY06(Z))

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摘要：

目的: 分析高原地区不同类型过敏性紫癜(Henoch-Schönlein purpura, HSP)藏族患者发病的相关危险因素, 为高原地区正确识别过敏性紫癜高危患者提供参考。方法: 选择2014年4月至2022年3月西藏自治区人民医院风湿免疫血液内科收治的304例藏族HSP患者的病例资料进行回顾性分析, 收集患者性别、年龄、过敏史、家族史、实验室指标[血红蛋白、血小板计数、嗜酸性粒细胞、C反应蛋白(C-reactive protein, CRP)、白蛋白、免疫球蛋白G、免疫球蛋白A、补体C3、补体C4和红细胞沉降率(erythrocyte sedimentation rate, ESR)]等数据, 采用单因素和多因素Logistic回归分析不同类型过敏性紫癜藏族患者发病的危险因素。结果: 肾型HSP患者表现出较高的IgA[(9.2±1.7) g/L vs. (6.4±2.4) g/L, P=0.015]、较低的补体C3[(203.3±21.6) mg/dL vs. (301.1±19.5) mg/dL, P=0.043]和补体C4[(33.5±2.3) mg/dL vs. (53.0±7.2) mg/dL, P=0.032], 腹型HSP患者表现出较低的血红蛋白[(119.6±19.6) g/L vs. (146.6±47.3) g/L, P=0.038]和血浆白蛋白[24.8 (22.1, 33.9) g/L vs. 32.6 (24.6, 35.1) g/L, P=0.045], 关节型HSP患者表现出更高的CRP[13.5 (0.2, 20.6) g/L vs. 7.5 (0.1, 15.2) g/L, P=0.036]和ESR[24 (5, 40) mm/h vs. 15 (4, 30) mm/h, P=0.049]。IgA升高、补体C4减低是肾型HSP的危险因素, 贫血、血浆白蛋白降低是腹型HSP的危险因素, CRP升高是关节型HSP的危险因素。结论: 高原地区不同类型的HSP临床特点存在差异, 对于高IgA血症、低补体C4、贫血、低白蛋白血症、CRP明显升高的患者应高度警惕, 给予早期有效干预可以提高临床疗效, 避免病情向重症发展, 改善预后。

关键词: 过敏性紫癜, 高原, 临床类型, 危险因素

Abstract:

Objective: To investigate the risk factors of different types of Henoch-Schönlein purpura (HSP) in Tibetan patients at high altitude, as to provide reference for correctly identifying high-risk patients. Methods: A retrospective study was used to analyze the 304 HSP patients admitted to Tibet Autonomous Region People's Hospital from April 2014 to March 2022. The gender, age, allergic history, family history, clinical type, laboratory indexes (hemoglobin, platelet count, eosinophil, C-reactive protein (CRP), albumin, immunoglobulin G, immunoglobulin A, complement C3 and C4) were analyzed retrospectively. Univariate and multivariate Logistic regression analysis to screen for risk factors affecting different types of HSP. Results: Renal HSP patients showed higher IgA [(9.2±1.7) g/L vs. (6.4±2.4) g/L, P=0.015], lower complement C3 [(203.3±21.6) mg/dL vs. (301.1±19.5) mg/dL, P=0.043], and complement C4 [(33.5±2.3) mg/dL vs. (53.0±7.2) mg/dL, P=0.032]. The patients with abdominal HSP showed lower levels of hemoglobin [(119.6±19.6) g/L vs. (146.6±47.3) g/L, P=0.038] and plasma albumin [24.8 (22.1, 33.9) g/L vs. 32.6 (24.6, 35.1) g/L, P=0.045]. The patients with articular HSP exhibited higher CRP [13.5 (0.2, 20.6) g/L vs. 7.5 (0.1, 15.2) g/L, P=0.036] and erythrocyte sedimentation rate (ESR) [24 (5, 40) mm/h vs. 15 (4, 30) mm/h, P=0.049]. Elevated IgA and decreased complement C4 were risk factors for renal HSP, anemia and decreased plasma albumin were risk factors for abdominal HSP, and elevated CRP was a risk factor for articular HSP. Conclusion: The clinical characteristics of different types of HSP in plateau areas were different. Patients with high IgA, low complement C4, anemia, hypoalbuminemia, and significantly elevated CRP should be highly vigilant. Early and effective intervention can improve the clinical efficacy, avoid severe development, and improve the prognosis

Key words: Henoch-Schönlein purpura (HSP), High altitude area, Subclinical manifestations, Risk factors

中图分类号: 

  • R554.6

表1

藏族HSP患者一般资料比较"

Items Renal involvement P Abdominal involvement P Articular involvement P
With Without With Without With Without
Male, n(%) 38 (45.2) 136 (61.8) 0.009 71 (57.7) 103 (56.9) 0.888 21(47.7) 153 (58.8) 0.168
Age/years, M(P25, P75) 27 (18, 41) 28 (18, 20) 0.586 24 (18, 41) 29 (18, 41) 0.045 26 (21, 39) 28 (20, 40) 0.497
Body mass index, ${\bar x}$ ± s 21.1±3.3 22.6±2.9 0.461 20.6±2.7 21.4±3.2 0.373 23.5±5.1 23.6±4.7 0.582
Allergy history, n(%) 30 (35.7) 82 (37.3) 0.801 65 (52.8) 57 (31.5) 0.000 16 (36.4) 96 (36.9) 0.943
Family history, n(%) 17 (20.2) 11 (5.0) 0.000 15 (12.2) 13 (7.2) 0.138 6 (13.6) 22 (8.5) 0.035

表2

肾型过敏性紫癜与非肾型过敏性紫癜实验室结果比较"

Projects Renal HSP (n=84) Without-R HSP (n=220) P
HGB/(g/L), ${\bar x}$ ± s 128.6±23.4 126.6±17.3 0.448
Neutrophils/(×109/L)，${\bar x}$ ± s 5.8±3.7 4.9±1.2 0.798
Eosinophils/(×109/L)，M(P25, P75) 0.02 (0.00, 0.03) 0.02 (0.00, 0.02) 0.849
Platelets/(×109/L)，${\bar x}$ ± s 498.7±80.2 394.2±53.7 0.041
CRP/(g/L), M(P25, P75) 9.4 (0.2, 19.4) 9.5 (0.1, 15.2) 0.737
ESR/(mm/h), M(P25, P75) 15 (4, 31) 15 (4, 30) 0.887
D-dimer/(mg/L), M(P25, P75) 0.27 (0.11, 0.98) 0.28 (0.12, 1.02) 0.053
Albumin/(g/L)，M(P25, P75) 30.8 (24.1, 33.9) 30.6 (24.6, 35.1) 0.796
IgG/(g/L)，${\bar x}$ ± s 18.9±2.5 18.8±3.4 0.258
IgA/(g/L)，${\bar x}$ ± s 9.2±1.7 6.4±2.4 0.015
IgM/(g/L)，${\bar x}$ ± s 1.6±0.4 1.5±0.7 0.912
IgE/(g/L)，${\bar x}$ ± s 795.1±37.2 577.6±25.3 0.041
Complement C3/(mg/dL)，${\bar x}$ ± s 203.3±21.6 301.1±19.5 0.043
Complement C4/(mg/dL)，${\bar x}$ ± s 33.5±2.3 53.0±7.2 0.032

表3

腹型过敏性紫癜与非腹型过敏性紫癜实验室结果比较"

Items Abdominal HSP (n=123) Without-A HSP (n=181) P
HGB/(g/L), ${\bar x}$ ± s 119.6±19.6 146.6±47.3 0.038
Neutrophils/(×109/L)，${\bar x}$ ± s 7.8±1.7 5.9±1.3 0.049
Eosinophils/(×109/L)，M(P25, P75) 0.02 (0.00, 0.03) 0.02 (0.00, 0.02) 0.849
Platelets/(×109/L), ${\bar x}$ ± s 598.7±80.2 394.2±53.7 0.026
CRP/(g/L)，M(P25, P75) 9.4 (0.2, 19.4) 9.5 (0.1, 15.2) 0.737
ESR/(mm/h)，M(P25, P75) 15 (4, 31) 15 (4, 30) 0.887
D-Dimer/(mg/L)，M(P25, P75) 0.27 (0.11, 0.98) 0.28 (0.12, 1.02) 0.053
Albumin/(g/L)，M(P25, P75) 24.8 (22.1, 33.9) 32.6 (24.6, 35.1) 0.045
IgG/(g/L), ${\bar x}$ ± s 15.8±2.8 17.2±3.6 0.289
IgA/(g/L), ${\bar x}$ ± s 6.2±3.2 6.4±2.4 0.985
IgM/(g/L), ${\bar x}$ ± s 1.7±0.7 1.6±0.2 0.998
IgE/(g/L), ${\bar x}$ ± s 532.1±31.2 577.6±21.3 0.761
Complement C3 (mg/dL), ${\bar x}$ ± s 403.3±36.6 375.2±27.8 0.998
Complement C4 (mg/dL), ${\bar x}$ ± s 58.5±3.6 53.0±7.2 0.979

表4

关节型过敏性紫癜与非关节型过敏性紫癜实验室结果比较"

Projects Articular HSP (n=44) Withont-Ar HSP (n=260) P
HGB/(g/L), ${\bar x}$ ± s 137.6±13.6 142.6±27.3 0.977
Neutrophils/(×109/L), ${\bar x}$ ± s 7.9±1.7 8.8±2.1 0.599
Eosinophils/(×109/L), M(P25, P75) 0.02 (0.00, 0.03) 0.02 (0.00, 0.02) 0.898
Platelets/(×109/L), ${\bar x}$ ± s 578.7±39.2 533.1±42.3 0.772
CRP/(g/L), M(P25, P75) 13.5 (0.2, 20.6) 7.5 (0.1, 15.2) 0.036
ESR/(mm/h), M(P25, P75) 24 (5, 40) 15 (4, 30) 0.049
D-dimer/(mg/L), M(P25, P75) 0.28 (0.11, 0.98) 0.28 (0.12, 1.02) 0.853
Albumin/(g/L), M(P25, P75) 29.8 (22.1, 33.9) 32.6 (24.6, 35.1) 0.645
IgG/(g/L), ${\bar x}$ ± s 18.8±2.2 17.8±3.0 0.364
IgA/(g/L), ${\bar x}$ ± s 6.2±3.6 6.4±2.5 0.999
IgM/(g/L), ${\bar x}$ ± s 1.2±0.4 1.4±0.3 0.999
IgE/(g/L), ${\bar x}$ ± s 537.1±31.2 575.6±21.3 0.766
Complement C3 (mg/dL), ${\bar x}$ ± s 403.3±37.1 375.2±27.8 0.995
Complement C4 (mg/dL), ${\bar x}$ ± s 50.5±8.8 53.0±9.1 0.980

表5

不同类型HSP患者的易感因素单因素分析"

Predisposing factors Clinical type P OR 95%CI
With Without
Renal involvement
    Male 38 136 0.009 0.764 0.291-1.339
    Family history 17 11 0.000 4.430 1.119-11.257
    Elevate of platelets 74 193 0.930 0.689 0.226-1.385
    Elevate of IgA 80 108 0.000 3.284 1.430-9.884
    Elevate of IgE 77 204 0.511 0.336 0.280-1.332
    Decrease of complement C3 46 119 0.916 3.058 1.066-10.729
    Decrease of complement C4 63 41 0.000 0.223 0.096-0.892
Abdominal involvement
    Age ≤ 20 years old 67 86 0.234 0.778 1.591-19.758
    Allergy history 65 57 0.000 2.469 1.120-15.169
    Anemia 109 65 0.000 3.472 1.984-5.276
    Elevate of neutrophils 103 152 0.956 0.722 0.135-1.398
    Elevate of platelets 112 155 0.156 0.987 1.233-4.920
    Decrease of albumin 88 64 0.000 2.405 1.025-5.647
Articular involvement
    Family history 6 22 0.035 3.059 1.182-7.334
    Elevate of ESR 38 228 0.805 0.382 0.175-3.445
    Elevate of CRP 30 242 0.020 1.973 1.069-4.328

表6

不同类型HSP患者易感因素多因素分析"

Risk factors B SE Wald P OR 95%CI
Renal involvement
    Male 1.329 0.744 3.256 0.986 1.002 0.834-1.017
    Family history 1.466 0.662 4.539 0.634 1.141 1.010-15.169
    Elevate of IgA 1.432 0.661 4.589 0.041 4.132 1.130-15.267
    Decrease of complement C4 1.756 0.823 5.319 0.044 2.405 1.025-5.647
Abdominal involvement
    Allergy history 1.734 0.643 7.195 0.978 5.603 1.591-19.758
    Anemia 1.426 0.663 4.538 0.034 4.132 1.120-15.169
    Decrease of albumin 0.879 0.445 4.067 0.044 2.405 1.025-5.647
Articular involvement
    Family history 1.726 0.784 4.597 0.749 1.382 1.075-3.445
    Elevate of CRP 1.255 0.787 5.203 0.003 4.331 1.357-9.644
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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