Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
Hubei Engineering Research Center for Skin Repair and Theranostics, Wuhan, China,
Dermatology. 2022;238(4):745-752. doi: 10.1159/000519665. Epub 2021 Nov 8.
Immunoglobulin A vasculitis (IgAV) is the most common vasculitis in children. Although childhood IgAV is generally considered as a self-limited disease, progressive course and poor prognosis could occur in some cases which mostly result from severe renal involvement and gastrointestinal (GI) involvement.
We performed a retrospective study of pediatric patients diagnosed as IgAV in our institution from 2016 to 2019. Patients were divided into groups based on the occurrence and severity of GI and renal involvement. Analysis of variance (ANOVA) and Kruskal-Wallis test were used to compare results of laboratory parameters among groups and prediction models were built by using logistic regression analysis.
A total of 286 patients were enrolled. GI involvement occurred in 148 (51.7%) patients, 30 (20.3%) of which were severe cases. Renal involvement developed in 120 (42.0%) patients, 22 (18.3%) of which were severe cases. Compared with patients with only cutaneous manifestations, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and D-dimer levels were higher in those with GI involvement, and D-dimer level was found to be positively associated with severity. Increased NLR and lower complement 3 (C3) were found in patients with renal involvement, but only C3 was relevant in distinguishing moderate and severe cases. The prediction model for severe renal involvement was: Logit (P) = 6.820 + 0.270 (age) + 0.508 (NLR) - 16.130 (C3), with an AUC of 0.914. The prediction model for severe GI involvement was: Logit (P) = -5.459 + 0.005 (WBC) + 1.355 (D-dimer) - 0.020 (NLR), with an AUC of 0.849.
Our data suggest C3 to be an exclusive predictor for severe renal involvement and D-dimer level to be positively associated with the severity of GI involvement. Prediction models consisting of the above parameters were built for obtaining prognostic information in the early phase of IgAV.
免疫球蛋白 A 血管炎（IgAV）是儿童中最常见的血管炎。尽管儿童 IgAV 通常被认为是一种自限性疾病，但在某些情况下，可能会出现进行性病程和不良预后，这主要是由于严重的肾脏受累和胃肠道（GI）受累。
我们对 2016 年至 2019 年在我院诊断为 IgAV 的儿科患者进行了回顾性研究。根据 GI 和肾脏受累的发生和严重程度将患者分为不同的组。采用方差分析（ANOVA）和 Kruskal-Wallis 检验比较各组实验室参数的结果，并通过逻辑回归分析建立预测模型。
共纳入 286 例患者。GI 受累发生在 148 例（51.7%）患者中，其中 30 例（20.3%）为严重病例。肾脏受累发生在 120 例（42.0%）患者中，其中 22 例（18.3%）为严重病例。与仅有皮肤表现的患者相比，GI 受累患者的白细胞（WBC）计数、中性粒细胞与淋巴细胞比值（NLR）和 D-二聚体水平较高，且 D-二聚体水平与严重程度呈正相关。肾脏受累患者的 NLR 升高，C3 降低，但只有 C3 与中重度病例有关。严重肾脏受累的预测模型为：Logit（P）=6.820+0.270（年龄）+0.508（NLR）-16.130（C3），AUC 为 0.914。严重 GI 受累的预测模型为：Logit（P）=-5.459+0.005（WBC）+1.355（D-二聚体）-0.020（NLR），AUC 为 0.849。
我们的数据表明，C3 是严重肾脏受累的唯一预测指标，D-二聚体水平与 GI 受累的严重程度呈正相关。基于上述参数建立的预测模型可在 IgAV 的早期阶段获得预后信息。
