ĐẶC ĐIỂM BỆNH NHÂN VIÊM MẠCH MÁU IGA CÓ TỔN THƯƠNG HỆ TIÊU HÓA TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: IgA vasculitis (IgAV) is the most common form of systemic vasculitis in children, primarily affecting the skin, joints, kidneys, and gastrointestinal (GI) tract. GI involvement occurs in approximately 50–70% of cases. The complications associated with GI involvement are not only potentially life-threatening but may also contribute to an increased risk of subsequent renal impairment. This study aims to characterize the clinical features of GI involvement and to identify risk factors associated with severe GI manifestations in pediatric patients diagnosed with IgAV. Subjects and methods: A descriptive case series study with follow-up. Results: Among the 68 patients, gastrointestinal (GI) involvement was observed in 82.4%, with 55.4% presenting with severe GI manifestations. The most common clinical symptoms were abdominal pain (100%), vomiting (82.1%), and gastrointestinal bleeding (25%). Severe GI involvement was more frequently observed in patients with skin lesions located on the lower back, in those whose GI symptoms appeared prior to or concurrently with the onset of skin lesions, and in patients with renal involvement or early kidney injury. The white blood cell count, platelet count, and neutrophil-to-lymphocyte ratio were significantly higher in patients with GI involvement. Compared to those with non-severe GI involvement, patients in the severe group experienced a longer duration of abdominal pain resolution and prolonged hospitalization following glucocorticoid therapy. Notably, patients who later experienced relapse had received a significantly shorter course of intravenous glucocorticoid therapy during their initial hospitalization. Additionally, those with severe GI involvement exhibited a prolonged time to abdominal pain resolution and longer hospital stays. Conclusions: Gastrointestinal involvement is a common manifestation of IgA vasculitis in children and may present with severe symptoms during the initial hospitalization. Careful monitoring and early initiation of glucocorticoid therapy may contribute to symptom improvement and reduced hospitalization duration, particularly in patients with identified risk factors such as renal involvement, skin lesions located above the waistline, or early onset of gastrointestinal symptoms.