Balmelli C, Laux-End R, Di Rocco D, Carvajal-Busslinger M I, Bianchetti M G
Medizinische Universitätskinderklinik, Inselspital Bern.
Schweiz Med Wochenschr. 1996 Feb 24;126(8):293-8.
We evaluated the records of 139 pediatric patients with Schönlein-Henoch purpura (aged 0.4 to 15.1 years, median 5.4 years), referred from 1974 to 1993 to the University Children's Hospital, Berne. An acute febrile illness preceded Henoch-Schönlein purpura in 83 (60%) out of the 139 children. The purpuric papules were distributed over the lower extremities and the buttocks in 68 patients (49%), and more extensively in the remaining 71 (51%). Joint tenderness or swelling was observed in 110 patients (79%). Abdominal involvement occurred in 92 patients (66%): abdominal pain (n = 63), melena or hematemesis (n = 23), and intussusception (n = 6). The following rather rare features were observed: scrotal swelling (n = 11), neurologic involvement (n = 3), and stenosing ureteritis (n = 1). A remission lasting at least 4 weeks occurred within 4 weeks in 84, within 5-8 weeks in 19, and within 9-53 weeks in 18 out of 121 patients. A relapse was observed in 10 subjects. Renal involvement occurred in 60 patients. Severe renal involvement, defined as proteinuria exceeding 40 mg/[m2 X h], occurred in 18 of the patients with renal involvement. Progredient renal failure developed in one male. Children with renal involvement tended to be older (6.6 versus 4.1 years) and to have more prolonged extrarenal manifestations (6 versus 3 weeks). It is concluded that in children with Schönlein-Henoch purpura extrarenal involvement often lasts more than one month. Its outcome is almost always favourable. Children with heavy proteinuria tend in some cases to develop renal failure. For these patients, new treatment regimens aimed at preventing renal failure warrant evaluation in prospective controlled studies.
我们评估了1974年至1993年间转诊至伯尔尼大学儿童医院的139例过敏性紫癜患儿（年龄0.4至15.1岁，中位数5.4岁）的病历。139名儿童中有83名（60%）在过敏性紫癜之前出现急性发热性疾病。68例患者（49%）的紫癜性丘疹分布于下肢和臀部，其余71例（51%）分布更为广泛。110例患者（79%）出现关节压痛或肿胀。92例患者（66%）出现腹部受累：腹痛（n = 63）、黑便或呕血（n = 23）以及肠套叠（n = 6）。观察到以下较为罕见的特征：阴囊肿胀（n = 11）、神经受累（n = 3）和狭窄性输尿管炎（n = 1）。121例患者中，84例在4周内出现持续至少4周的缓解，19例在5 - 8周内缓解，18例在9 - 53周内缓解。10名受试者出现复发。60例患者出现肾脏受累。肾脏受累定义为蛋白尿超过40 mg/[m2×h]，18例肾脏受累患者出现严重肾脏受累。1名男性患儿发展为进行性肾衰竭。肾脏受累的儿童往往年龄较大（6.6岁对4.1岁），肾外表现持续时间更长（6周对3周）。结论是，过敏性紫癜患儿的肾外受累通常持续超过1个月。其预后几乎总是良好的。重度蛋白尿患儿在某些情况下易发展为肾衰竭。对于这些患者，旨在预防肾衰竭的新治疗方案值得在前瞻性对照研究中进行评估。
