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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
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