| Objectives:Henoch-Schonlein purpura(HSP) is the most common vasculitis in childhood. In recent years, the incidence rate of HSP showed an upward trend year by year. The renal injury is the most common and severe complications of HSP, affects the treatment time and prognosis of HSP. Therefore it’s crucial to make an early detection of renal damage and give timely treatment. Urine trace protein is a sensitive index in reflecting early renal damage HSP and may appear abnormal before urine routine examination. It’s always controversial about the effects of glucocorticoid in the treatment of HSP. Recently some studies showed that early application of glucocorticoid can prevent the renal damage of allergic purpura. This paper aims to explore whether early use of glucocorticoid can prevent the occurrence of kidney damage, the application time of glucocorticoid in Henoch-Schonlein purpura is different on the prevention of the renal damage, to guide the clinical treatment, reduct renal damage rate of Henoch-Schonlein purpura, improve the prognosis.Methods:From January2011to December2011we collected80children cases with HSP who had no abnormality urine routine from the department of pediatric nephrology group of the Second Affiliated Hospital of Hebei Medical University. They were randomly divided into two groups. The first group was short-term use glucocorticoid group (prednisolone injection1-1.5mg/kg.d intravened during hospitalization.The prednisolone can gradual reduct after symptoms were relieved if there were no renal damage during treatment.About10-14days,people can discharge with glucocorticoid withdrawal).The second group is for a longer period of time use glucocorticoid group(prednisolone injection1-1.5mg/kg.d intravened during hospitalization.The prednisolone can gradual reduct after symptoms were relieved if there were no renal damage during treatment. About10days, the prednisolone changed to prednisone acetate lmg/kg.d morning meal service.The prednisone acetate can gradual reduct without renal damage during treatment and reduced stop1month). The next day and the end of the2week, the fourth week, the second month after the addmission, we monitored two groups routine urine and the urine trace protein (urinary albumin, urinary beta2microglobulin). After admission we routinely give intravenous cimetidine (20-40mg/kg.d), VitC; oral dipyridamole tablets, cetirizine hydrochloride tablets; avoid abnormal protein diet therapy. No thrombocytopenic children routinely receive low intravenous molecular heparin calcium (100U/kg.d). Pediatric patients with infection receive intravenous antibiotics to control infection. Pediatric patients with obvious gastrointestinal symptoms receive fasted, antispasmodic and protecting gastrointestinal therapeutic treatment. To compare renal impairment occurrence of the two group. Using SPSS16.0statistical analysis software to analysis the above clinical feature of different groups.Results:(1) If we use urine routine as the indexes, the renal damage occurrence rate of this research object is16.25%. This rate significantly lower the30%-60%incidence of the majority literature reported. Early use of glucocorticoid can prevent renal damage of HSP.(2) If we use urine trace protein (one or two positive) as indexes, the renal damage occurrence rate of the short term application of glucocorticoid group is90%, relatively the long term steroid group is92.5%. There are no statistical difference in this two groups (P>0.05).It will not be better to prevent the renal damage of HSP whether extended the glucocorticoid application time.(3) In the early time when there were no abnormality urine routine, the positive rate of urinary micraolbumin(MA) was60%and urine beta2microglobulin(β2-MG) was36.25%. The combined detection’s positive rate80%is higher than the positive rates of MA and β2-MG, the differences were statistically significant (P<0.05).The renal pathological damage have appeared in the early time when there were no abnormally of urine routine.The MA and β2-MG can be used as early renal damage in children with HSP diagnosis indicators. Joint-related protein detection can improve the accuracy of diagnosis.(4) The MA and β2-MG declined significantly after trentment, the differences were statistically significant (P<0.05).This can indicate that our current teatment options are available, can effectively less excrete of the urinary protein.(5) The renal damage rates of skin type, abdominal type, joint type, mixed type HSP were87.5%,90.5%,90%,100%. There are no statistical difference between various types of HSP(P>0.05).(6) The kidney damage probability in men and women were91.5%(43/47) and90.9%(30/33), the difference was not statistically significant (P>0.05).Conclusions:(1) The urine protein test can be used as early renal damage in children with HSP diagnosis indicators. Joint-related protein detection can improve the accuracy of diagnosis.(2) Early use of glucocorticoid can prevent renal damage of HSP. It will not be better to prevent the renal damage of HSP whether extended the glucocorticoid application time.(3) Gender and the type of HSP have no effect on renal damage. |
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