| Objective: Tocompare the differences of demographical data, possible causes, clinical manifestations, laboratory and auxiliary findings, endoscopy exams, pathological changes of endoscopic biopsies and renal biopsies, therapy methods and outcomes between patients in adult group and childhood group with Ig A vasculitis.And to analyze the factors associated with poor prognosis for Ig A vasculitis. Our study here was to provide reference for the clinical diagnosis and therapy of Ig A vasculitis.Methods:781 patients with Ig A vasculitis between January 2013 and December 2014 were analyzed retrospectively and statistically. These data include common information, clinical manifestations, laboratory and auxiliary examination, endoscopy exams, pathological changes of endoscopic biopsies and renal biopsies, therapy methods and outcomes. All patients were divided into two groups according to American Rheumatism Association(ARA)[1] and EULAR/PRINTO/PRES[2]. Teenagers group ?20 years and adults group > 20 years. Weanalyze the collected data with the SPSS software.Results: 1)The groups consisted of 781 patients, 127 adult patients(16.3%) and 654 child patients(83.7%), and the ratio of adult to child was 1:5.15. The age of the onset varied from 1.9 to 71 years old. A slightly male predominance was noted in bothadult and childhood groups(52.0%vs. 58.1%). The distribution of the time when the disease occurred differed between the two groups, it occurred least in summer in both groups, winter was the most in the adult group and autumn the most in the child group. 2) The precipitating events included upper respiratory infection, being tired, taking large amount of movement,vaccinations, tumorsand so on. 13 of the 127 adult patients(10.2%) had a history of upper respiratory tract infection, 19 cases(15.0%) were concerned with food or drugs, 5 cases(3.9%) were concerned withtaking large amount of movement, 90 cases(70.8%) didn't reveal evident predisposing factors in the adult group. There were 115 cases(17.6%) in the child group had a history of upper respiratory tract infection, 22 cases(3.4%) were associated with food or drugs, 1 case(0.2%) with the vaccination, 6 cases(0.9%) with taking large amount of movement, 510 cases couldn't figure out exact inducement. 3) 781 cases(100%) all had typical purpura, and it occurred more in lower extremities in both groups. The purpura in upper extremities and trunk were more seen in the adult group, and the purpura in the buttock, facial area and the ears were more seen in the child group. Joint involvement occurred more frequently in childhood group. There were 30 cases(23.6%) in the adult group and 262 cases(40.1%) in the child group. Gastrointestinal manifestations betweenadult and childhood groups didn't differ much. There were 54 cases(41.0%) in the adult group and 419 cases(64.1%) in the child group. The most common manifestations of gastrointestinal involvement were abdominal pain and gastrointestinal bleeding. Renal involvement occurred more in adult group. There were 91 cases(71.7%) in the adult group and 308 cases(47.1%) in the child group. The main manifestations of renal involvement were hematuria and/or proteinuria. 4) The adult group: leukocytosis was found in 23 cases of the 91 patients(25.3%) in the adult group, and thrombocytosis was found in 20 cases of the 91 patients(22.0%), eosinopenia was found in 6 cases of the 90 patients(6.7%), the decreased mean platelet volume was found in 13 cases of the 88 patients(14.8%), the decreased Ig A level was found in 12 cases of the 52 patients(23.1%), the increased erythrocyte sedimentation rate level was found in 9 cases of the 53 patients(17.0%). The child group: leukocytosis was found in 117 cases of the 306 patients(38.2%) in the child group, and thrombocytosis was found in 159 cases of the 306 patients(52.0%), eosinopenia was found in 71 cases of the 289 patients(24.6%), the decreased mean platelet volume was found in 27 cases of the 287 patients(9.4%), the decreased Ig A level was found in 17 cases of the 231 patients(7.4%), the increased erythrocyte sedimentation rate level was found in 38 cases of the 269 patients(14.1%). 5) There were 18/12 patients undertook gastroscopy/colonoscopy in the adult group, and 16/3 in the child group, and we can find different lesions.It was the duodenal bulb that was most frequently involved in the upper gastrointestinal tract and terminal ileum and ileocecus in the lower gastrointestinal tract. The common lesions were oedema and erosion. Almost all of the biopsy spicemens from the gastrointestinal tract demonstrated non-special inflammation, there was only one demonstrated leukocytoclastic vasculitis, and immunofluorescent staining on optic microscopy revealed Ig A depositing in vessel walls. 6)There were 21 patients with renal involvement in the adult group had been performed renal biopsy, and 145 patients in the child group. All of the biopsies revealed different degree of renal injury. 7) The treatment includedconventional treatment, aggressive therapy(glucocorticoid and immunosuppressant), blood purification and surgeon. The immunosuppressive therapy was important except for the conventional treatment. 8) The patients in the adult group with renal involvement had a worse tendency than the patients with renal involvement in the child group, and age less than 20 years old at the time of the diagnosis, hematuria and proteinuria were risk factors for the relapse of the disease.Conclusion: Ig A vasculitis can happen in any age, but the teenager is easier to be seen than adult, most of those occured in winter or autumn. It had a slightly male predominance in both groups. Upper respiratory tract infection ranked the first and food or drugs that may be allergic the second in the child group, it was just the opposite in the adult group. More attention should be paid for muti-system damage of Ig A vasculitis, especially the renal involvement, for its influencing the long-term prognosis of the patients. |
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