Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (02): 143 -149. doi: 10.3877/cma.j.issn.1673-5250.2019.02.004

Special Issue:

Original Article

Risk factors of renal involvement in children with primary Henoch-Schönlein purpura in the early stage

Xiaomei Sun1, Yang Cao1, Liang Dai1, Feiyang Sun1, Liqun Dong1,()   

  1. 1. Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2018-10-30 Revised:2019-03-15 Published:2019-04-01
  • Corresponding author: Liqun Dong
  • About author:
    Corresponding author: Dong Liqun, Email:
  • Supported by:
    Scientific Research Project of Health and Family Planning Commission of Sichuan Province(16P238); Project of Pediatric Clinical Medical Research Center of Sichuan Province(2017-46-4); the Forth Baili Scientific Research Project of Chinese Journal of Pediatrics(B2016-C-3); Clinical Medical Research Project of West China Second University Hospital, Sichuan University(K012)
Objective

To explore the risk factors of renal involvement in children with primary Henoch-Sch?nlein purpura (HSP) in the early stage, and provide clinical references for early intervention of HSP these children with risk factors of renal involvement.

Methods

A total of 1 402 children with primary HSP who hospitalized in Department of Pediatrics, West China Second University Hospital, Sichuan University from January 2011 to December 2015 were included in this study. According to whether combined with renal involvement or not in the early stage of HSP, these children were divided into the renal involvement group (n=423) and control group (n=979, without renal involvement). Their demographic data and clinical manifestation were collected by retrospective method. Constituent ratios of gender, age of onset, residential area, season of onset and duration from symptoms onset to diagnosis, and incidences of skin rash, gastrointestinal symptoms, joint swelling and pain, renal involvement, angioneurotic edema, and nervous system involvement in the early stage were compared between two groups by chi-square test. Multivariate unconditional logistic regression analysis was used to assess the risk factors of renal involvement in children with HSP in the early stage. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013. The guardians of all children signed the clinical research informed consents.

Results

①Among the 1 402 children with HSP, 423 cases (30.17%) occurred renal involvement in the early stage of onset, 937 cases (66.84%) with gastrointestinal symptoms, 609 cases (43.33%) with joint swelling and pain, 352 cases (25.11%) with angioneurotic edema, 31 cases (2.21%) with nervous system involvement, and all cases (100%) with skin rash. ②Univariate analysis of the influencing factors of renal involvement in the early stage of HSP showed that there were statistically significant differences between two groups in constituent ratios of age of onset, season of onset, and duration from symptoms onset to diagnosis (χ2=53.682, P<0.001; χ2=11.990, P=0.007; χ2=14.635, P<0.001). And the proportions of children lived in rural areas, without joint swelling or pain and with angioneurotic edema in renal involvement group all were statistically higher than those in control group, and all the differences were statistically significant (χ2=10.032, P=0.002; χ2=6.514, P=0.011; χ2=6.362, P=0.012). ③Multivariate unconditional logistic regression analysis results showed that the onset age of HSP≥5 years old (≥5-7 years old, OR=2.23, 95%CI: 1.42-3.51, P<0.001; ≥7-9 years old, OR=2.38, 95%CI: 1.51-3.76, P<0.001; ≥9 years old, OR=4.11, 95%CI: 2.65-6.36, P<0.001), onset in the autumn (OR=1.61, 95%CI: 1.09-2.37, P=0.014) and winter (OR=1.79, 95%CI: 1.09-2.37, P=0.001), the duration from symptoms onset to diagnosis ≥8 d (OR=1.59, 95%CI: 1.17-2.17, P=0.004), living in rural areas (OR=1.37, 95%CI: 1.07-1.76, P=0.012) and combined with angioneurotic edema (OR=1.74, 95%CI: 1.32-2.31, P<0.001) were independent risk factors for renal involvement in children with HSP in the early stage. While combined with joint swelling and pain (OR=0.77, 95%CI: 0.60-0.99, P=0.038) was independent protective factors for renal involvement in children with HSP in the early stage.

Conclusions

Results in this study first show that HSP children combined with angioneurotic edema have high risk of renal involvement in the early stage of HSP and reconfirm that onset age of HSP ≥5 years old, onset in autumn or winter, duration from symptoms onset to diagnosis ≥8 d, and residence in rural areas all are the independent risk factors for renal involvements in children with primary HSP in the early stage.

表1 1 402例过敏性紫癜患儿发病早期的临床资料分析[例数(%)]
表2 2组过敏性紫癜患儿发病早期肾脏受累影响因素的单因素分析结果[例数(%)]
表3 过敏性紫癜患儿发病早期肾脏受累影响因素的多因素非条件logistic回归分析的变量含义及赋值情况
表4 过敏性紫癜患儿发病早期肾脏受累影响因素的多因素非条件logistic回归分析结果
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