中国中西医结合杂志2025，Vol.45Issue(2)：169-175,7.DOI:10.7661/j.cjim.20250117.034
紫癜性肾炎患儿复发因素研究
Study on Factors of Recurrence in Children with Henoch-Schönlein Purpura Nephritis
摘要
Abstract
Objective To analyze the risk factors affecting the long-term prognosis of children with Henoch-Schönlein purpura nephritis(HSPN)in Henan region.Methods A total of 3 774 HSPN children with abnormal urine protein were screened from the Department of Pediatrics of the First Affiliated Hospital of Henan University of Chinese Medicine.A total of 2 115 patients were followed up,and the recurrence of urinary protein,whether it progresses to end stage renal disease(ESRD),and other adverse events in children with HSPN within 1 year,1-3 years,3-6 years,and more than 6 years(≤ 11 years)of the follow-up period were counted.Results For children with a disease cycle of within 1 year during the follow-up,a high 24 h urinary protein value and a high IgE level at baseline were risk factors(P＜0.001,P＜0.05)for the recurrence of HSPN,while onset during summer and autumn were seasonal protective factors against relapse in children with HSPN(P＜0.001,P＜0.05).The ROC curve analysis showed that the critical value of 24 h urinary protein for recurrence was 13.1605 mg/kg.The onset seasons of summer and autumn were protective factors for reducing the recurrence of HSPN in children.For children with a disease cycle of 1-3 years,the risk factors for recurrence were age,recurrence within 1 year,abnormal urine test for more than 3 months,and onset in winter(P＜0.05).For the 3-6-year disease cycle,the risk factors for recurrence were abnormal urine test for more than 3 months,recurrence within 1 year,recurrence within 1-3 years,and onset in winter(P＜0.05).Risk factors for recurrence at ≥ 6 years of follow-up were abnormal urine test for more than 3 months,recurrence within 1 year,recurrence within 1-3 years,as well as age and female gender(P＜0.05).In the long-term safety follow-up,there were 2 cases of vomiting after cyclophosphamide shock,28 cases of diarrhea after taking Chinese medicine,7 cases of abnormal menstruation(delayed and irregular)during taking tretinoin tablets for adolescent female children,which returned to normal after stopping the drug,1 case of gastrointestinal discomfort after switching to kunxian capsules.After hormone administration,there were 1 case of femoral head necrosis,two cases of bone fractures and six cases of centripetal obesity.A total of 12 end-point events occurred,including 9 cases of ESRD,1 case of acute renal failure that progressed to ESRD,and 2 cases of child death(P＜0.05).Age and high levels of prothrombin time and fibrinogen were determined to be independent risk factors for the development of ESRD and death in children with HSPN based on Cox regression analysis.Conclusions A high 24 h urinary protein level(≥50 mg/kg)and IgE before treatment are important factors for assisting in monitoring the short-term recurrence of children with HSPN.Age,onset in winter,abnormal urine test for more than 3 months,and the frequency of early recurrence are the main factors for assisting in monitoring long-term recurrence.Older age of onset and blood hypercoagulability of HSPN children may be important factors leading to their poor prognosis.关键词
儿童/紫癜性肾炎/复发因素/远期随访Key words
children/Henoch-Schönlein purpura nephritis/relapse factors/long-term follow-up引用本文复制引用
高敏,丁樱,吴瑞红,代彦林,徐炎,韩姗姗,陈玉琴..紫癜性肾炎患儿复发因素研究[J].中国中西医结合杂志,2025,45(2):169-175,7.基金项目
国家自然科学基金青年科学基金项目(No.82305311,No.82305310) （No.82305311,No.82305310）
国医大师工作室建设项目(No.国中医药人教发[2022]245号) （No.国中医药人教发[2022]245号）
河南省特色骨干学科中医学第二批学科建设项目(No.STG-ZYX05-202140) （No.STG-ZYX05-202140）
