過敏性紫斑症的臨床表現與預後，比較兒童與成人的差異

The Clinical Manifestations and Outcomes of Henoch-Schönlein Purpura: Differences between Children and Adults

目的：過敏性紫斑症是兒童最常見的血管炎，不過成人也可能有此疾病。本研究的目的是想比較兒童與成人在過敏性紫斑症的臨床表現與預後上的差異。方法：本研究是回溯性研究，統計近10年內在一間三級轉診醫院的過敏性紫斑症個案，一共有70名兒童與22名成人。結果：下肢紫斑在兒童與成人族群皆是最常見的開始症狀。腹痛症狀在兒童族群較常見，而成人族群比較常有下肢水腫的症狀出現（P＜0.05）。成人族群比較常有腎臟的影響（P＜0.05）。血小板增多症在兒童族群較常發現，而成人族群則比較常有IgA升高的情況（P＜0.05）。87.1%的兒童完全康復，而在成人族群只有45.5%完全康復。過敏性紫斑症在成人族群，比較會進展到慢性腎病（P＜0.05）。單變項分析顯示年齡大於18歲，血尿，蛋白尿，一開始的急性腎損傷，復發以及血紅素小於10是進展到慢性腎病的危險因子。多變項分析顯示在疾病開始之初即有出現急性腎損傷的病人，在之後比較會進展到慢性腎病。結論：過敏性紫斑症在兒童與成人有不同的臨床表現。兒童的預後較好，但是成人有較嚴重的臨床症狀與腎臟的影響。對於那些有可能會進展到慢性腎病的病人，長期的追蹤是有需要的。

Objectives: Henoch-Schönlein purpura (HSP) is the most common vasculitis in children that also affects adults. However, not a lot is known about the differences in clinical manifestations and outcomes amongthe two affected populations. Thus, the purpose of this study is to examine the distinction between children and adults with HSP. Methods: This 10-year retrospective study enrolled 70 children and 22 adult HSP patients in a tertiary referral hospital. Results: Lower extremities purpura was the most common initial symptom in both groups. However, abdominal pain was significantly more frequent in children, while adults had a higher frequency of lower limb edema and renal involvement (P<0.05). In addition, thrombocytosis was more frequently observed in children, while elevated IgA was more common in adults (P<0.05). 87.1% of children completely recovered from HSP while only 45.5% of adults did so (P<0.05). Consequently, adults had a significantly higher frequency of progressing towards chronic kidney disease (P<0.05). Univariate analysis revealed that age>18 years, hematuria, gross hematuria, proteinuria, nephrotic range proteinuria, initial acute kidney injury, recurrence, and hemoglobin <10 g/dl were poor prognostic factors for progression towards chronic kidney diseases. Moreover, multivariate analysis demonstrated acute kidney injury at the initial onset of the disease to be significantly associated with progression towards chronic kidney disease in HSP atients. Conclusion: Children and adults displayed different clinical features of HSP. Prognosis is favorable for most children with HSP, while adult patients experienced more severe clinical symptoms and worse renal outcomes. Long-term follow-ups are recommended for HSP patients presenting with risk factors for progression towards chronic kidney diseases.