Zeng Chuanwen, Gesang Deji, Dawa Quzhen, De Ji, Pubu Zhaxi, Baima Yangzhen, Xu Yuanyuan
Department of Pediatrics, Shannan People's Hospital of Tibet Autonomous Region, Shannan 856000, Tibet Autonomous Region, China.
Department of Pediatric Intensive Care Unit, Anhui Provincial Children's Hospital, Hefei 230051, Anhui, China. Xu Yuanyuan is working on the Department of Pediatrics, Shannan People's Hospital of Tibet Autonomous Region, Shannan 856000, Tibet Autonomous Region, China. Corresponding author: Xu Yuanyuan, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Jun;31(6):742-745. doi: 10.3760/cma.j.issn.2095-4352.2019.06.016.
To analyze probable risk factors to Henoch-Schönlein purpura (HSP) in Tibetan children so as to bring evidences for correct identification of high-risk children in plateau areas.
140 high-altitude Tibetan children with HSP admitted to Shannan People's Hospital of Tibet Autonomous Region from October 2015 to October 2018 were enrolled, and 140 high-altitude Tibetan healthy children and 140 plain area HSP children were selected as the control. Gender, age, family history, allergy, past history (rheumatic disease, autoimmune disease, asthma), clinical phenotype, biochemical markers (antibody positive rate, platelet count and hemoglobin), clinical efficacy and recurrence were retrospective analyzed. The risk factors of HSP in the high-altitude Tibetan children were analyzed by univariate and multivariate Logistic regression analysis.
It was shown by univariate analysis that the proportion of allergic history and past history of high-altitude HSP children was higher than those of high-altitude healthy children (allergic history: 35.7% vs. 11.4%, past history: 21.4% vs. 5.7%, both P < 0.05). Compared with plain area HSP children, the age of high-altitude HSP children was increased (years old: 6.5±2.3 vs. 5.3±2.2), the clinical phenotype was more complex (37.9% vs. 57.1% for simple skin and limb type, 21.4% vs. 14.3% for abdominal type, 28.6% vs. 21.4% for renal type, 7.1% vs. 5.0% for brain or lung type, 5.0% vs. 2.2% for complex type), the positive rate of antibody was increased (64.3% vs. 50.0%), platelet count was decreased (×10/L: 116.2±12.3 vs. 176.8±35.4), hemoglobin level was increased (g/L: 125.6±15.7 vs. 113.8±10.9), recurrence rate was lower (4.3% vs. 10.7%), and the difference was statistically significant (all P < 0.05). It was shown by multivariate Logistic regression analysis that age, allergic history and past history were independent risk factors for HSP in high-altitude Tibetan children [age: odds ratio (OR) = 1.263, 95% confidence interval (95%CI) = 1.063-1.968; allergic history: OR = 1.765, 95%CI = 1.326-2.452, past history: OR = 1.421, 95%CI = 1.102-2.232, all P < 0.05]. Clinical phenotypic and biochemical indexes were important risk factors affecting the clinical efficacy of high-altitude Tibetan HSP children (non-simple skin and limb type: OR = 2.123, 95%CI = 1.623-2.869; antibody positive: OR = 1.865, 95%CI = 1.502-2.768; both P < 0.05).
It is different of HSP occurrence in Tibetan children from plateau and plain areas. Attention should be paid to screening age, allergy history, past history, clinical phenotype, antibody positive and other high risk children. Early and effective intervention can improve clinical curative effect and reduce recurrence.
分析藏族儿童过敏性紫癜（HSP）的可能危险因素，为高原地区高危儿童的正确识别提供依据。
选取2015年10月至2018年10月在西藏自治区山南市人民医院收治的140例高原藏族HSP患儿，选取140例高原藏族健康儿童及140例平原地区HSP患儿作为对照。对性别、年龄、家族史、过敏史、既往史（风湿性疾病、自身免疫性疾病、哮喘）、临床表型、生化指标（抗体阳性率、血小板计数及血红蛋白）、临床疗效及复发情况进行回顾性分析。采用单因素及多因素Logistic回归分析高原藏族儿童HSP的危险因素。
单因素分析显示，高原HSP患儿的过敏史及既往史比例高于高原健康儿童（过敏史：35.7%比11.4%，既往史：21.4%比5.7%，均P<0.05）。与平原地区HSP患儿相比，高原HSP患儿年龄增大（岁：6.5±2.3比5.3±2.2），临床表型更复杂（单纯皮肤及四肢型：37.9%比57.1%，腹型：21.4%比14.3%，肾型：28.6%比21.4%，脑或肺型：7.1%比5.0%，复合型：5.0%比2.2%），抗体阳性率升高（64.3%比50.0%），血小板计数降低（×10/L：116.2±12.3比176.8±35.4），血红蛋白水平升高（g/L：125.6±15.7比113.8±10.9），复发率降低（4.3%比10.7%），差异均有统计学意义（均P<0.05）。多因素Logistic回归分析显示，年龄、过敏史及既往史是高原藏族儿童HSP的独立危险因素[年龄：比值比（OR）=1.263，95%置信区间（95%CI）=1.063-1.968；过敏史：OR=1.765，95%CI=1.326-2.452，既往史：OR=1.421，95%CI=1.102-2.232，均P<0.05]。临床表型及生化指标是影响高原藏族HSP患儿临床疗效的重要危险因素（非单纯皮肤及四肢型：OR=2.123，95%CI=1.623-2.869；抗体阳性：OR=1.865，95%CI=1.502-2.768；均P<0.05）。
高原地区藏族儿童HSP的发生情况与平原地区不同。应重视对年龄、过敏史、既往史、临床表型、抗体阳性等高危儿童的筛查。早期有效干预可提高临床疗效，降低复发率。
