Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Acad Dermatol. 2012 Oct;67(4):612-6. doi: 10.1016/j.jaad.2011.11.946. Epub 2012 Jan 13.
Detection of IgM in lesional skin of adult patients with Henoch-Schönlein purpura via direct immunofluorescence (DIF) has been associated with the presence of renal disease.
We sought to examine whether DIF findings of skin biopsy specimens and distribution of skin lesions were associated with the presence of systemic disease, including renal, gastrointestinal tract, and joint involvement.
We performed a retrospective review of adult patients with Henoch-Schönlein purpura seen at Mayo Clinic between 1992 and 2011.
Of the 87 patients (mean age, 46.1 years), 51 (59%) were male. A total of 39 patients (45%) had renal disease; 32 (37%), gastrointestinal tract involvement; 39 (45%), joint involvement; and 65 (75%), some systemic involvement. In all, 61 patients (70%) had cutaneous lesions above the waist. The DIF findings showed the presence of IgA in all 87 patients (100%). In addition, findings were positive for IgM in 32 patients (37%); IgG in 3 patients (3%); C3 in 75 patients (87%); and fibrinogen in 78 patients (92%). IgM was not found to be significantly associated with renal disease (P = .10); however, absence of fibrinogen was correlated with presence of renal involvement (P = .04). No other correlations were detected between DIF findings and systemic disease. Lesions above the waist were not significantly associated with renal (P = .12) or any (P = .76) systemic involvement.
This study is retrospective.
Neither IgM in lesional skin nor distribution of skin lesions above the waist was a reliable indicator of renal or systemic disease in adults with Henoch-Schönlein purpura.
通过直接免疫荧光法（DIF）在成人过敏性紫癜患者皮损中检测到 IgM 与肾脏疾病的存在有关。
我们试图研究皮肤活检标本的 DIF 结果和皮肤损伤的分布是否与全身性疾病（包括肾脏、胃肠道和关节受累）的存在相关。
我们对 1992 年至 2011 年间在梅奥诊所就诊的成人过敏性紫癜患者进行了回顾性研究。
87 例患者（平均年龄 46.1 岁）中，男性 51 例（59%）。共有 39 例（45%）患者有肾脏疾病；32 例（37%）胃肠道受累；39 例（45%）关节受累；65 例（75%）有全身性受累。共有 61 例（70%）患者腰部以上有皮肤损伤。87 例患者的 DIF 检查均显示 IgA 存在（100%）。此外，32 例（37%）患者 IgM 阳性；3 例（3%）患者 IgG 阳性；75 例（87%）患者 C3 阳性；78 例（92%）患者纤维蛋白原阳性。未发现 IgM 与肾脏疾病显著相关（P=0.10）；然而，纤维蛋白原缺失与肾脏受累相关（P=0.04）。在 DIF 检查结果与系统性疾病之间未检测到其他相关性。腰部以上的皮损与肾脏（P=0.12）或任何（P=0.76）系统性疾病均无显著相关性。
本研究为回顾性研究。
在成人过敏性紫癜患者中，皮损中 IgM 的存在或腰部以上皮损的分布均不能可靠地预测肾脏或系统性疾病。
