Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 923-928. doi: 10.19723/j.issn.1671-167X.2023.05.022

Previous Articles     Next Articles

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))

RICH HTML

   

PDF (PC)

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

CLC Number: 

  • R554.6

Table 1

Comparison of general data of the cases of HSP in Tibetan patients"

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

Table 2

Comparison of laboratory examination results between renal and without-R HSP"

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

Table 3

Comparison of laboratory examination results between abdominal and without-A HSP"

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

Table 4

Comparison of laboratory examination results between Articular and without-Ar HSP"

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

Table 5

Univariate analysis of clinical and laboratory features for the development of different type of HSP"

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

Table 6

Multivariate analysis of clinical and laboratory features for the development of different type of HSP"

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
1 Wakaki H , Ishikura K . Henoch-Schönlein 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 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
3 Cakici EK , Suker EDK , Ozlu SG , et al. MEFV gene mutations in children with Henoch-Schönlein purpura and their correlations-do mutations matter[J]. Clin Rheumatol, 2019, 38 (7): 1947- 1952.
doi: 10.1007/s10067-019-04489-2
4 Gardner-Medwin JM , Dolezalova P , Cummins C , et al. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins[J]. Lancet, 2002, 360 (9341): 1197- 1202.
doi: 10.1016/S0140-6736(02)11279-7
5 Hetland LE , Susrud KS , Lindahl KH , et al. Henoch-Schönlein purpura: A literature review[J]. Acta Derm Venereol, 2017, 97 (10): 1160- 1166.
doi: 10.2340/00015555-2733
6 Wang H , Das L , Hoh SF , et al. Urinalysis monitoring in children with Henoch-Schönlein purpura: Is it time to revise[J]. Int J Rheum Dis, 2019, 22 (7): 1271- 1277.
doi: 10.1111/1756-185X.13552
7 孙小妹, 戴亮, 孙飞扬, 等. 成都地区与川西高原地区过敏性紫癜患儿临床特征比较分析[J]. 现代预防医学, 2018, 45 (12): 2274-2276, 2287.
8 Delbet JD , Hogan J , Aoun B , et al. Clinical outcomes in children with Henoch-Schönlein purpura nephritis without crescents[J]. Pediatr Nephrol, 2017, 32 (7): 1193- 1199.
doi: 10.1007/s00467-017-3604-9
9 Novak J , Vu HL , Novak L , et al. Interactions of human mesangial cells with IgA and IgA-containing immune complexes[J]. Kidney Int, 2002, 62 (2): 465- 475.
doi: 10.1046/j.1523-1755.2002.00477.x
10 Tabel Y , Inanc FC , Dogan DG , et al. Clinical features of children with Henoch-Schönlein purpura: risk factors associated with renal involvement[J]. Iran J Kidney Dis, 2012, 6 (4): 269- 274.
11 Reamy BV , Servey JT , Williams PM . Henoch-Schönlein purpura (IgA vasculitis): Rapid evidence review[J]. Am Fam Physician, 2020, 102 (4): 229- 233.
12 Audemard-Verger A , Pillebout E , Guillevin L , et al. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects[J]. Autoimmun Rev, 2015, 14 (7): 579- 585.
doi: 10.1016/j.autrev.2015.02.003
13 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.
14 曾传文, 格桑德吉, 达瓦曲珍, 等. 高原藏族儿童过敏性紫癜相关文献因素分析[J]. 中华危重病急救医学, 2019, 31 (6): 742- 745.
15 Tan J , Tang Y , Xu Y , et al. The clinicopathological characteristics of Henoch-Schönlein purpura nephritis with presentation of nephrotic syndrome[J]. Kidney Blood Press Res, 2019, 44 (4): 754- 764.
doi: 10.1159/000501459
16 Buscatti IM , Casella BB , Aikawa NE , et al. Henoch-Schönlein purpura nephritis: Initial risk factors and outcomes in a Latin American tertiary center[J]. Clin Rheumatol, 2018, 37 (5): 1319- 1324.
doi: 10.1007/s10067-017-3972-3
17 Karadag SG , Tanatar A , Sonmez HE , et al. The clinical spectrum of Henoch-Schönlein purpura in children: A single-center study[J]. Clin Rheumatol, 2019, 38 (6): 1707- 1714.
doi: 10.1007/s10067-019-04460-1
18 魏慧, 罗增, 次旦央宗, 等. 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.
[1] Hui WEI, Jingfeng ZHANG, Zhongqiang YAO, Jinxia ZHAO. Clinical characteristics and relevant factors of rheumatoid arthritis patients with anemia of chronic disease [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 307-312.
[2] Jie ZHAO, Chun FU, Xiujuan ZHAO, Haiyan XUE, Shu LI, Zhenzhou WANG, Fengxue ZHU. Risk factors for ventilator-associated pneumonia in patients with chest trauma in intensive care unit [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 351-358.
[3] Bowen LI, Qiang ZHANG, Yixin SUN. Establishment and validation of a risk prediction model for scoliosis after Nuss procedure in children and young adults with pectus excavatum [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 941-946.
[4] Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.
[5] Wei LIU, Wen GUO, Zhe GUO, Chunyan LI, Yunlong LI, Siqi LIU, Liang ZHANG, Hui SONG. Risk factors associated with non-radiographic bone erosion in patients with gout [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 735-739.
[6] Mengxi LU, Qiuping LIU, Tianjing ZHOU, Xiaofei LIU, Yexiang SUN, Peng SHEN, Hongbo LIN, Xun TANG, Pei GAO. Association of triglyceride-glucose index and cardiovascular disease in a community-based Chinese cohort [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 430-435.
[7] Huaqiu GUO, Zhe WANG, Xue YANG, Jie BAI. Clinical features and risk factors of patients with oral bleeding in dental emergency [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 142-147.
[8] Minting DENG, Nan WANG, Bin XIA, Yuming ZHAO, Junxia ZHU. Factors associated with spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 148-153.
[9] Yukai LI, Hongyan WANG, Liang LUO, Yun LI, Chun LI. Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1036-1040.
[10] Yang TIAN, Yongzheng HAN, Jiao LI, Mingya WANG, Yinyin QU, Jingchao FANG, Hui JIN, Min LI, Jun WANG, Mao XU, Shenglin WANG, Xiangyang GUO. Incidence and risk factors of postoperative epidural hematoma following anterior cervical spine surgery [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1058-1064.
[11] Mingrui WANG, Jinhui LAI, Jiaxiang JI, Xinwei TANG, Haopu HU, Qi WANG, Kexin XU, Tao XU, Hao HU. Risk factors for decreased quality of life in patients with kidney stones predicted by the Chinese version of Wisconsin stone quality of life questionnaire [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1069-1074.
[12] Zhicun LI, Tianyu WU, Lei LIANG, Yu FAN, Yisen MENG, Qian ZHANG. Risk factors analysis and nomogram model construction of postoperative pathological upgrade of prostate cancer patients with single core positive biopsy [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 896-901.
[13] Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.
[14] Yan CHEN,Kuangmeng LI,Kai HONG,Shudong ZHANG,Jianxing CHENG,Zhongjie ZHENG,Wenhao TANG,Lianming ZHAO,Haitao ZHANG,Hui JIANG,Haocheng LIN. Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 680-686.
[15] Bo PANG,Tongjun GUO,Xi CHEN,Huaqi GUO,Jiazhang SHI,Juan CHEN,Xinmei WANG,Yaoyan LI,Anqi SHAN,Hengyi YU,Jing HUANG,Naijun TANG,Yan WANG,Xinbiao GUO,Guoxing LI,Shaowei WU. Personal nitrogen oxides exposure levels and related influencing factors in adults over 35 years old in Tianjin and Shanghai [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 700-707.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd