Rigante Donato, Guerriero Cristina, Silvaroli Sara, Paradiso Filomena Valentina, Sodero Giorgio, Laferrera Francesco, Franceschi Francesco, Candelli Marcello
Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Università Cattolica Sacro Cuore, 00168 Rome, Italy.
Children (Basel). 2024 Feb 7;11(2):215. doi: 10.3390/children11020215.
: IgA vasculitis (IgAV), a predominantly pediatric leukocytoclastic disease, has an unpredictable, though largely benign, evolution. The aim of this study was to retrospectively investigate any potential clinical or laboratory predictors of gastrointestinal involvement in a single-center cohort of children with IgAV. : A total of 195 children with a history of IgAV, regularly followed-up for an average period of 1 ± 2.6 years via outpatients clinics of the pediatric rheumatology unit in our University, were assessed, analyzing their clinical and laboratory variables in relationship with their disease evolution and outcome. : Univariate analysis showed that a higher neutrophil granulocyte count and lower lymphocyte count (expressed as a percentage of the total white blood cells) were significantly associated with the presence of gastrointestinal involvement at the first examination (65.2 ± 13% versus 58.8 ± 12%, = 0.02, and 26.4 ± 11% versus 32.1 ± 11%, = 0.02, respectively). A positive pharyngeal swab for , a deficiency of 25-hydroxyvitamin D, a persistence of purpuric rash for more than 1 month, and purpuric lesions in the genital area were also associated with gastrointestinal involvement ( = 0.0001, = 0.0001, = 0.007 and = 0.001, respectively). However, multiple logistic regressions with correction for the patients' sex and age showed that lower 25-hydroxyvitamin D levels, persistent rash, and genital lesions were independently and significantly associated with signs of gastrointestinal involvement. We then performed a secondary analysis (both univariate and multivariate) to investigate whether vitamin D deficiency was associated with other IgAV manifestations: we found that only 25-hydroxyvitamin D deficiency remained significantly associated with gastrointestinal involvement in IgAV. : Patients with IgAV and vitamin D deficiency might be more prone to developing gastrointestinal manifestations of variable severity.
IgA 血管炎(IgAV)是一种主要发生于儿童的白细胞破碎性疾病,其病情发展虽大多为良性,但难以预测。本研究旨在回顾性调查单中心队列中 IgAV 患儿胃肠道受累的潜在临床或实验室预测因素。
共有 195 例有 IgAV 病史的患儿接受了评估,这些患儿通过我校儿科风湿病科门诊定期随访,平均随访时间为 1±2.6 年,分析其临床和实验室变量与疾病演变及结局的关系。
单因素分析显示,首次检查时较高的中性粒细胞计数和较低的淋巴细胞计数(以白细胞总数的百分比表示)与胃肠道受累显著相关(分别为 65.2±13% 对 58.8±12%,P = 0.02;26.4±11% 对 32.1±11%,P = 0.02)。咽拭子检测A组链球菌阳性、25-羟维生素 D 缺乏、紫癜皮疹持续超过 1 个月以及生殖器部位的紫癜病变也与胃肠道受累相关(分别为 P = 0.0001、P = 0.0001、P = 0.007 和 P = 0.001)。然而,在对患者性别和年龄进行校正的多因素逻辑回归分析中,较低的 25-羟维生素 D 水平、持续性皮疹和生殖器病变与胃肠道受累体征独立且显著相关。然后,我们进行了一项二次分析(单因素和多因素),以研究维生素 D 缺乏是否与其他 IgAV 表现相关:我们发现只有 25-羟维生素 D 缺乏与 IgAV 中的胃肠道受累仍显著相关。
IgAV 且维生素 D 缺乏的患者可能更容易出现不同严重程度的胃肠道表现。