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目的探讨儿童难治性过敏性紫癜(HSP)的临床特点,以提高对该病的认识。方法回顾性分析苏州大学附属儿童医院2005年1月-2008年1月收治的25例难治性HSP患儿的临床资料、实验室检查,总结其发病特点、临床表现、治疗及预后,并与同期50例一般HSP患儿(对照组)进行比较,应用SPSS12.0软件进行统计学分析。结果难治性HSP患儿25例均有不同程度的消化道症状,年龄4～8岁17例(68%),腹痛持续时间较对照组显著延长(P<0.01),16例(64%)有反复消化道出血,2例并肠套叠,4例误诊为急性阑尾炎。25例难治性HSP患儿肾脏受损发生率(44%)显著高于对照组(8%)(P<0.01),24h尿蛋白定量和尿微量蛋白升高率与对照组比较均有显著性差异(Pa<0.01)。25例难治性HSP患儿血淋巴细胞亚群CD3、CD4以及CD8水平均低于对照组(Pa<0.05),CD19水平高于对照组(P<0.05)。25例难治性HSP患儿加用免疫抑制剂治疗后明显好转。结论难治性HSP临床表现复杂,病程长、易反复,大部分为混合型HSP,消化道症状表现严重,肾脏受损程度明显,细胞免疫功能紊乱,单纯激素治疗效果差,需加用免疫抑制剂,积极治疗可减少复发。
Objective To investigate the clinical features of refractory Henoch-Schonlein purpura (HSP) in children so as to raise awareness of the disease. Methods The clinical data and laboratory tests of 25 refractory HSP children admitted to Children’s Hospital Affiliated to Soochow University from January 2005 to January 2008 were retrospectively analyzed. The characteristics, clinical manifestation, treatment and prognosis of HSP were retrospectively analyzed. In the same period, 50 cases of general HSP children (control group) were compared, and SPSS12.0 software was used for statistical analysis. Results Twenty-five patients with refractory HSP had varying degrees of gastrointestinal symptoms, 17 (68%) aged 4 to 8 years, and the duration of abdominal pain was significantly longer than that of the control group (P <0.01). Sixteen patients (64% There are recurrent gastrointestinal bleeding, 2 cases and intussusception, 4 cases misdiagnosed as acute appendicitis. The incidence of kidney damage (44%) in 25 patients with refractory HSP was significantly higher than that in the control group (8%) (P <0.01). The urinary protein excretion and urine microalbuminuria in 24h group were significantly higher than those in control group Sex differences (Pa <0.01). The levels of CD3, CD4 and CD8 in 25 cases of refractory HSP were lower than those in the control group (P <0.05), and the level of CD19 was higher than that in the control group (P <0.05). 25 cases of refractory HSP in children with immunosuppressive agents significantly improved after treatment. Conclusion The clinical manifestations of refractory HSP are complex, with long duration and easy to be repeated. Most of them are mixed HSP. The symptoms of gastrointestinal tract are serious, the damage of kidney is obvious, the cellular immune function disorder is poor. The effect of simple hormone therapy is poor. Agents, aggressive treatment can reduce recurrence.