成人过敏性血管炎与过敏性紫癜的比较临床与流行病学研究。

Comparative clinical and epidemiological study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adults.

作者信息

García-Porrúa C, González-Gay M A

机构信息

Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain.

出版信息

Semin Arthritis Rheum. 1999 Jun;28(6):404-12. doi: 10.1016/s0049-0172(99)80006-7.

DOI:10.1016/s0049-0172(99)80006-7

PMID:10406408

Abstract

OBJECTIVES

To assess the incidence and clinical features of adults with hypersensitivity vasculitis (HV) and Henoch-SchOnlein purpura (HSP) in a well-defined population.

METHODS

Retrospective study of an unselected population of adult patients (>20 years) with biopsy-proven cutaneous vasculitis diagnosed as having HV or HSP who presented at a primary hospital between 1988 and 1997. Patients with cutaneous vasculitis secondary to collagen vascular diseases, neoplasia, severe infections, and those with other well-defined clinical entities were excluded. Patients were classified as having either HV or HSP according to the criteria proposed by Michel et al (J Rheumatol 1992;19:721-28).

RESULTS

Fifty-six adults (35 men/21 women), were classified as having HV and 27 adults as having HSP (19 men/8 women). The annual incidence rate for HV was 29.7/million and 14.3/million for HSP. At the onset of the disease, adults with HSP were younger than those with HV (46+/-18 years versus 59+/-18 years in HV; P = .005). Precipitating events were found in 50% of HV and in 30% of HSP patients. A history of drug therapy before the onset of vasculitis was found in 46% of HV and in 26% of HSP (P = .074). At disease onset, skin lesions were the most common manifestation in both groups. During the disease course, adults with HSP had joint manifestations more commonly (59% in HSP v25% in HV; P < .003) and more gastrointestinal (82% v 5% in HV; P < .001) and renal complications (48% v 5% in HV; P < .001). HSP subjects required more aggressive therapy consisting of steroids (P < .001) or cytotoxic agents (P < .001). After 37+/-28 (median, 31) months, complete recovery was observed in 98% of adults with HV. After 40+/-27 (median, 36) months, complete recovery was observed in only 67% of adults with HSP (P < .001). Renal insufficiency was observed in 8% of adults with HSP.

CONCLUSIONS

In adults, HV and HSP as defined by these criteria, behave as two well-differentiated diseases. HV has a milder course and lack of severe complications, and HSP a higher risk of gastrointestinal and renal complications.

摘要

目的

评估在一个明确界定的人群中，成人过敏性血管炎（HV）和过敏性紫癜（HSP）的发病率及临床特征。

方法

对1988年至1997年间在一家基层医院就诊的、经活检证实为皮肤血管炎且诊断为HV或HSP的未经过筛选的成年患者（年龄>20岁）进行回顾性研究。排除继发于胶原血管疾病、肿瘤、严重感染的皮肤血管炎患者以及患有其他明确临床病症的患者。根据Michel等人提出的标准（《风湿病学杂志》1992年；19：721 - 28）将患者分为HV或HSP。

结果

56名成年人（35名男性/21名女性）被分类为患有HV，27名成年人被分类为患有HSP（19名男性/8名女性）。HV的年发病率为29.7/百万，HSP为14.3/百万。在疾病发作时，患有HSP的成年人比患有HV的成年人年轻（HSP组为46±18岁，HV组为59±18岁；P = 0.005）。50%的HV患者和30%的HSP患者有诱发事件。46%的HV患者和26%的HSP患者在血管炎发作前有药物治疗史（P = 0.074）。在疾病发作时，皮肤病变是两组中最常见的表现。在疾病过程中，患有HSP的成年人关节表现更常见（HSP组为59%，HV组为25%；P < 0.003），胃肠道并发症（HSP组为82%，HV组为5%；P < 0.001）和肾脏并发症（HSP组为48%，HV组为5%；P < 0.001）也更多。HSP患者需要更积极的治疗，包括使用类固醇（P < 0.001）或细胞毒性药物（P < 0.001）。37±28（中位数，31）个月后，98%的HV成年患者实现完全康复。40±27（中位数，36）个月后，只有67%的HSP成年患者实现完全康复（P < 0.001）。8%的HSP成年患者出现肾功能不全。