| Objective(s):Part I: To investigate the incidence of cutaneous vasculitis in a hospital in Yunnan,and to analyze and summarize the clinical and histopathological features of different types of cutaneous vasculitis,in order to lay a foundation for the early diagnosis and differential diagnosis of vasculitis.Part II: To explore the predictive value of D-dimer in allergic vasculitis,and to provide noninvasive,stable and reliable biological reference index for the diagnosis of allergic vasculitis.Methods: Part I: Through retrospective investigation and analysis of clinical and pathological data of patients diagnosed with cutaneous vasculitis by clinical and histopathological examination in the Department of Dermatology,First Affiliated Hospital of Kunming Medical University from January 2015 to December 2022,the patients were divided into 6 groups with 15-year-old as a group to analyze the clinical and pathological features of different types of vasculitis.Part II: Divide the patients with Henoch-Schonlein purpura and allergic vasculitis into two groups,compare the clinical data of the two groups,draw the receiver operating characteristic(ROC)curve,calculate the area under the curve,and analyze the sensitivity,specificity and the best predictive cut-off value of serum D-dimer in the diagnosis of allergic vasculitis.Results: Part I: 1.In the first part of 436 cases of cutaneous vasculitis,the male to female ratio was 1:1.87.The age of onset ranged from 2 to 83 years old,with an average age of(38.73±18.089)years and a median age of 39 years.The highest proportion of onset age was 136 cases(31.19%)in the young group aged 16-30 years.Among them,347 cases(79.59%)were leukocytoclastic vasculitis with the highest incidence.The highest proportion of leukocytoclastic vasculitis was nodular vasculitis(128 cases,36.89%),followed by allergic vasculitis(105 cases,30.26%),urticarial vasculitis(42 cases,12.10%)and anaphylactoid purpura(34 cases,9.80%).2.Cutaneous vasculitis mainly involved lower limbs in 252 cases(57.80%).The most common site of leukocytoclastic vasculitis was the lower extremities in 195cases(56.20%).The most common site of livid angiopathy was the lower extremities in 42 cases(87.5%).Nodular vasculitis,allergic vasculitis and allergic purpura were involved in the lower extremities,which were 83 cases(64.84%),78 cases(74.29%)and 19 cases(55.88%)respectively.The most common lesion site of urticarial vasculitis was generalized in 35 cases(83.33%).3.Erythema and/or dark erythema were the most common skin lesions in 242cases(55.50%),followed by petechiae and/or ecchymosis in 137 cases(31.42%).In leukocytoclastic vasculitis,erythema and/or dark erythema were the most common manifestations in 194 cases(55.91%),petechiae and/or ecchymosis in 110 cases(31.70%),and nodules in 106 cases(30.55%).The most common type of lesions in nodular vasculitis was red spot and/or dark erythema in 97 cases(75.78%),followed by nodules in 87 cases(67.07%).The most common skin lesions of allergic vasculitis were petechiae and/or ecchymosis in 56 cases(53.33%),followed by erythema and/or dark red spots in 45 cases(42.86%).The most common lesions of urticarial vasculitis were erythema and/or dark erythema in 35 cases(83.33%)and wheals in 23 cases(54.76%).Petechiae and/or petechiae were the most common lesions in Henoch-Schonlein purpura(33 cases,97.06%).The most common lesion of livedovascular disease was livedoreticular/erythema in 29 cases(60.42%),followed by ulcer and/or necrosis in 28 cases(58.33%).There were significant differences in the lesions of different types of cutaneous vasculitis(P<0.001).4.Among 436 cases of cutaneous vasculitis,the most common symptom was pain in 181 cases(41.51%).In nodular vasculitis,91 patients(71.09%)had pain.5.The histopathological findings of nodular vasculitis were as follows: 73 cases(57.03%)involved fat lobules,55 cases(42.97%)involved fat lobules and septa,36cases(28.13%)involved medium-sized vessels,and the rest involved small vessels.The main histopathological manifestations of allergic vasculitis were small vessel involvement in 100 cases(95.24%)and erythrocyte extravasation in 84 cases(80.00%).Histopathological findings of urticarial vasculitis were as follows:superficial and middle dermis involvement in 23 cases(54.76%),small vessels involvement in 42 cases(100.00%),and scattered inflammatory cells in 32 cases(76.19%).Small vessels were involved in 34 cases of Henoch-Schonlein purpura(100.00%),and 34 cases(100.00%)had erythrocyte extravasation.Part II:1.30 cases of allergic vasculitis,including 12 cases of male(40.00%),18 cases of female(60.00%),male to female ratio of 1:1.5,onset age of 41.5(17.75,52.00)years;37 cases of allergic purpura,including 13 males(35.10%)and 24females(64.86%),the ratio of male to female was 1:1.85,the onset age was 44.00(17.00,67.00)years old;There was no significant difference in age and sex between allergic vasculitis and Henoch-Schonlein purpura(P>0.05).The average body weight of patients with allergic vasculitis was(59.95±17.51)kg,and that of patients with Henoch-Schonlein purpura was(59.70±12.55)kg.There was no significant difference between the two groups(P>0.05).Among the cases of allergic vasculitis,18 cases(60.00%)occurred in both lower extremities.Among the cases of Henoch-Schonlein purpura,the cases of lower limbs were the most,accounting for 19 cases(51.35%).There was no significant difference in the number of patients with the same site in different diseases(allergic vasculitis and Henoch-Schonlein purpura)(P> 0.05).2.In 30 cases of allergic vasculitis,24 cases(80.00%)showed petechiae and ecchymosis,22 cases(73.33%)showed ulcer and necrosis,13 cases(43.33%)showed blister and blood blister,10 cases(33.33%)showed papule and nodule,7 cases(23.33%)showed erythema and dark erythema.19 cases(63.33%)felt pain and 15cases(50.00%)felt pruritus.In 37 cases of Henoch-Schonlein purpura,petechiae and ecchymosis were found in 37 cases(100.00%),vesicles,blood vesicles,ulcers and necrosis in 2 cases(5.41%),and nodules in 0 cases(0.00%).Pruritus was found in 8cases(21.62%)and pain in 5 cases(13.51%).There were significant differences in skin lesions and subjective symptoms between the two groups(P<0.05).3.There was no significant difference in Ig G,Ig A,Ig M,Ig E,C4,FIB,FDP,ALB between allergic vasculitis and Henoch-Schonlein purpura(P>0.05).The D-D value of allergic vasculitis group(1.20(0.58,2.08))was higher than that of Henoch-Schonlein purpura group(0.43(0.21,1.03)).The C3 value of Henoch-Schonlein purpura group(1.06±0.23)was lower than that of allergic vasculitis group(1.18±0.16),and the difference between the two groups was statistically significant(P=0.023).4.Results of receiver operating characteristic(ROC)curves:The area under the curve(AUC)of D-dimer in the diagnosis of allergic vasculitis was 0.707,the sensitivity was 96.67%,the specificity was 48.65%,and Youden index was0.4532.According to the maximum Youden index,the optimal cut-off value of D-dimer was 0.33.5.In allergic vasculitis,there was no significant difference in Ig G,Ig A,Ig M,Ig E,C3,C4 and fibrinogen(FIB)between high D-dimer group and normal D-dimer group(P>0.05).Albumin in the high D-dimer group(ALB)Mean is The average level of FDP was 4.25(2.80,8.40),which was higher than that of 1.15(1.00,1.30)in normal D-dimer group.There was significant difference between high D-dimer group and normal D-dimer group(P<0.05).6.In Henoch-Schonlein purpura,there was no significant difference in Ig G,Ig A,Ig M,Ig E,C3,C4 and FIB between high D-dimer group and normal D-dimer group(P>0.05).Albumin in the high D-dimer group(ALB)Mean is(38.07±3.64),higher than that of normal D-dimer group(ALB)(42.05±4.70),FDP(5.35(2.80,7.45))was higher than FDP(1.30(1.00,1.700))in normal D-dimer group.There was significant difference between high D-dimer group and normal D-dimer group(P<0.05).Conclusion(s):PartⅠ: 1.Skin vasculitis is more common in women,and the onset age is mainly young and middle-aged.2.The highest incidence of cutaneous vasculitis was leukocytoclastic vasculitis,followed by nodular vasculitis,allergic vasculitis,urticarial vasculitis and anaphylactoid purpura.3.Cutaneous vasculitis was more common in both lower limbs,with erythema and/or dark erythema,petechiae and/or petechiae and nodules as the main lesions.The most common site of leukocytoclastic vasculitis is also the lower extremities.4.Skin vasculitis lesions,pain degree and the size of the involved vessels,vascular and surrounding inflammatory infiltration degree,depth of the lesion site.PartⅡ:1.Allergic vasculitis is more prone to erythema,dark erythema,papules,nodules,blisters,blood blisters,necrosis,ulcers than allergic purpura;Patients with Henoch-Schonlein purpura were more prone to petechiae and ecchymosis than patients with allergic vasculitis Patients with allergic vasculitis were more prone to pain and itching than patients with allergic purpura.2.The total D-dimer value in patients with allergic vasculitis was higher than that in patients with Henoch-Schonlein purpura,and the total C3 value in patients with Henoch-Schonlein purpura was lower than that in patients with allergic vasculitis.There were significant differences in D-dimer and C3 between the two groups.3.There was no significant difference in the biological indexes of Ig G,Ig A,Ig M,Ig E,C4,FIB,FDP and ALB between allergic vasculitis and Henoch-Schonlein purpura.4.In allergic vasculitis and Henoch-Schonlein purpura,there was no correlation between the increase of D-dimer and the changes of Ig G,Ig A,Ig M,Ig E,C3,C4,FIB.5.The higher the value of D-dimer,the higher the value of D-dimer in the diagnosis of allergic vasculitis,but it can not replace the histopathological examination. |
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