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Title: [Risk factors associated with different types of Henoch-Schönlein purpura in Tibetan patients at high altitude].
Author: Wei H, Ci-dan-yang-zongDepartment of Rheumatology, Immunology and Hematology, Tibet Autonomous Region People's Hospital, Lhasa 850000, China., Yi-xi-la-muDepartment of Rheumatology, Immunology and Hematology, Tibet Autonomous Region People's Hospital, Lhasa 850000, China., Bai-ma-yang-jinDepartment of Rheumatology, Immunology and Hematology, Tibet Autonomous Region People's Hospital, Lhasa 850000, China..
Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2023 Oct 18; 55(5):923-928. PubMed ID: 37807749.
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. 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。

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