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

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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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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
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