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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1072-1077. doi: 10.19723/j.issn.1671-167X.2021.06.011

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Analysis of clinical characteristics of Henoch-Schonlein purpura patients from different altitudes in plateau areas

WEI Hui1,Luo-zeng 2,Ci-dan-yang-zong 2,Bai-ma-yang-jin 2,△()   

  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:2021-07-26 Online:2021-12-18 Published:2021-12-13
  • Contact: Bai-ma-yang-jin E-mail:13518986955@163.com

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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

CLC Number: 

  • R593

Table 1

Comparison of general data of patients with abdominal HSP"

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

Table 2

Comparison of laboratory examination results of patients with abdominal HSP"

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/(109//L) 4.8±1.1 5.2±3.3 5.8±4.7 0.516
Eosinophils/(109//L) 0.02 (0.00-0.03) 0.01 (0.00-0.03) 0.02 (0.00-0.02) 0.712
Platelets/(109//L) 456.4±81.2 498.3±76.9 512.1±55.0ab 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

Table 3

Comparison of gastroscopy results of patients with abdominal HSP from different altitude"

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

Table 4

Comparison of colonoscopy results of patients with abdominal HSP from different altitude"

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

Table 5

Comparison of treatment and outcome of patients with abdominal HSP"

Treatment and outcome Lower altitude (n=33) Medium altitude (n=74) High altitude (n=83) P
A B A B A B
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
[1] Wakaki H, Ishikura K. Henoch-Schonlein nephritis with nephrotic state in children: Predictors of poor outcomes[J]. Pediatr Nephrol, 2012, 27(2):335.
doi: 10.1007/s00467-011-2052-1
[2] Gardner-Medwin JM, Dolezalova P, Cummins C, et al. Incidence of Henoch-Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins[J]. Lancet, 2002, 360(9341):1197-1202.
pmid: 12401245
[3] Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised international chapel hill consensus conference nomenclature of vasculitides[J]. Arthritis Rheum, 2013, 65(1):1-11.
doi: 10.1002/art.37715
[4] Hetland LE, Susrud KS, Lindahl KH, et al. Henoch-Schonlein purpura: A literature review[J]. Acta Derm Venereol, 2017, 97(10):1160-1166.
doi: 10.2340/00015555-2733
[5] Audemard-Verger A, Pillebout E, Guillevin L, et al. IgA vasculitis (Henoch-Shonlein purpura) in adults: Diagnostic and therapeutic aspects[J]. Autoimmun Rev, 2015, 14(7):579-585.
doi: 10.1016/j.autrev.2015.02.003 pmid: 25688001
[6] Karadag SG, Tanatar A, Sonmez HE, et al. The clinical spectrum of Henoch-Schonlein purpura in children: A single-center study[J]. Clin Rheum, 2019, 38(6):1707-1714.
doi: 10.1007/s10067-019-04460-1
[7] 央珍, 郭琳, 熊昊, 等. 西藏高原地区儿童过敏性紫癜的临床分析[J]. 中国当代儿科杂志, 2014, 16(12):1231-1235.
[8] 刘文, 魏万林, 田国祥, 等. 高原辅助呼吸机基础生理原理的研究[J]. 医疗卫生装备, 2010, 31(08):22-23.
[9] Lei WT, Tsai PL, Chu SH, et al. Incidence and risk factors for recurrent Henoch-Schonlein purpura in children from a 16-year nationwide database[J]. Pediatr Rheumatol Online J, 2018, 16(1):25.
doi: 10.1186/s12969-018-0247-8
[10] 蔡婷婷, 达娃次仁, 周红恩, 等. 高原地区不同海拔高度急性肺栓塞临床特征分析[J]. 中华结核和呼吸杂志, 2019, 42(10):755-759.
[11] Bigham AW, Julian CG, Wilson MJ, et al. Maternal PRKAA1 and EDNRA genotypes are associated with birth weight, and PRKAA1 with uterine artery diameter and metabolic homeostasis at high altitude[J]. Physiol Genomics, 2014, 46(18):687-697.
doi: 10.1152/physiolgenomics.00063.2014
[12] Ueda H, Miyazaki Y, Tsuboi N, et al. Clinical and pathological characteristics of elderly Japanese patients with IgA vasculitis with nephritis: A case series[J]. Intern Med, 2019, 58(1):31-38.
doi: 10.2169/internalmedicine.1379-18
[13] Burger D, Wittmann J. Education and imaging. Gastrointestinal: Henoch-Schonlein purpura[J]. J Gastroenterol Hepatol, 2009, 24(8):1473.
doi: 10.1111/jgh.2009.24.issue-8
[14] de Oliveira GT, Martins SS, Deboni M, et al. Cutaneous vasculitis in ulcerative colitis mimicking Henoch-Schonlein purpura[J]. J Crohns Colitis, 2013, 7(2):e69-73.
doi: 10.1016/j.crohns.2012.05.001
[15] Tanaka T, Hiramatsu K, Saito Y, et al. The usefulness of video capsule endoscopy in evaluating gastrointestinal manifestations of immunoglobulin a vasculitis[J]. Intern Med, 2019, 58(14):1979-1985.
doi: 10.2169/internalmedicine.2097-18
[16] Bogdanovic R. Henoch-Schonlein purpura nephritis in children: Risk factors, prevention and treatment[J]. Acta Paediatr, 2009, 98(12):1882-1889.
doi: 10.1111/apa.2009.98.issue-12
[17] Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, double-blind, placebo-controlled trial[J]. J Pediatr, 2006. 149(2):241-247.
doi: 10.1016/j.jpeds.2006.03.024
[18] Kang HS, Chung HS, Kang KS, et al. High-dose methylprednisolone pulse therapy for treatment of refractory intestinal involvement caused by Henoch-Schonlein purpura: a case report[J]. J Med Case Rep, 2015, 42(9):65.
[19] Lamireau T, Rebouissoux L, Hehunstre JP. Intravenous immunoglobulin therapy for severe digestive manifestations of Henoch-Schonlein purpura[J]. Acta Paediatr, 2001, 90(9):1081-1082.
pmid: 11683201
[20] Kusuda A, MIgita K, Tsuboi M, et al. Successful treatment of adult-onset Henoch-Schonlein purpura nephritis with high-dose immunoglobulins[J]. Intern Med, 1999, 38(4):376-379.
doi: 10.2169/internalmedicine.38.376
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