Tancrede-Bohin E, Ochonisky S, Vignon-Pennamen M D, Flageul B, Morel P, Rybojad M
Department of Dermatology, Hôpital Saint-Louis, Paris, France.
Arch Dermatol. 1997 Apr;133(4):438-42. doi: 10.1001/archderm.133.4.438.
To evaluate the incidence of extracutaneous manifestations and to identify predictive factors for renal involvement in adult patients with Schönlein-Henoch purpura.
Retrospective study with a comparative analysis of patients with and without renal involvement.
Patients who were attending the dermatologic department of an academic medical center.
In patients with purpura of the lower limbs and cutaneous vascular IgA deposits for which cases were recorded from 1985 to 1993, the following selection criteria were used: age older than 15 years and absence of thrombocytopenia, of IgA deposits in the basement membrane zone, and of a known hematologic or connective tissue disorder.
Clinical and biological data, results of histological studies, and findings from direct immunofluorescence studies of skin biopsy specimens were compared in patients with and without renal involvement.
Fifty-seven patients were included: 23% had an IgA glomerulonephritis confirmed by results of a renal biopsy, and a further 26% showed abnormalities on urine microscopy. Joint and gastrointestinal involvement was noted in, respectively, 33% and 19% of the patients. A comparative analysis of patients with and without renal involvement failed to reveal significant differences with regard to age, sex, the presence of bullous or necrotic cutaneous lesions, gastrointestinal or joint involvement, histological features, and findings from direct immunofluorescence studies. An IgA glomerulonephritis was significantly associated with purpura above the waist (P = .03), a recent infectious history (P = .02), pyrexia (P = .01), and biological markers of inflammation (P = .006).
Despite a lower incidence of systemic involvement compared with that in other published series, the incidence of renal involvement remained high (ie, between 23% and 49%). A recent infectious history, pyrexia, the spread of purpura to the trunk, and biological markers of inflammation were predictive factors for renal involvement.
评估成人过敏性紫癜患者皮肤外表现的发生率，并确定肾脏受累的预测因素。
对有和无肾脏受累的患者进行比较分析的回顾性研究。
一家学术医疗中心皮肤科就诊的患者。
选取1985年至1993年记录的下肢紫癜且皮肤血管有IgA沉积的患者，采用以下入选标准：年龄大于15岁，无血小板减少、基底膜区IgA沉积，且无已知血液系统或结缔组织疾病。
比较有和无肾脏受累患者的临床和生物学数据、组织学研究结果以及皮肤活检标本直接免疫荧光研究结果。
纳入57例患者：23%经肾活检结果证实患有IgA肾小球肾炎，另有26%尿液镜检异常。分别有33%和19%的患者出现关节和胃肠道受累。对有和无肾脏受累患者的比较分析未发现年龄、性别、有无大疱性或坏死性皮肤病变、胃肠道或关节受累、组织学特征以及直接免疫荧光研究结果方面的显著差异。IgA肾小球肾炎与腰部以上紫癜（P = 0.03）、近期感染史（P = 0.02）、发热（P = 0.01）以及炎症生物学标志物（P = 0.006）显著相关。
尽管与其他已发表系列研究相比，全身受累的发生率较低，但肾脏受累的发生率仍然较高（即23%至49%）。近期感染史、发热、紫癜蔓延至躯干以及炎症生物学标志物是肾脏受累的预测因素。
