| Objective: To analyze the effects of Helicobacter pylori(Hp)infection on digestive tract symptoms,rash,renal damage,joint damage,laboratory indexes,abdominal imaging,endoscopic findings and other clinical features in children with Henoch-Schonlein purpura(HSP).Methods: Children admitted to Children’s Hospital of Chongqing Medical University from January 2014 to November 2020 who were diagnosed with HSP and were tested for Hp were selected as subjects.According to the presence or lack of Hp infection,the children were divided into Hp positive group and Hp negative group.These children were followed up for 6 months to compare the differences in clinical characteristics between the two groups.Results: 72 cases of children with HSP were included in this study,including 25/72 cases in Hp positive group and 47/72 cases in Hp negative group.1.Clinical manifestations:(1)Renal involvement: 46/72cases(63.9%)developed Henoch-Schonlein purpura nephritis during the follow-up,including 20/25 cases(80.0%)in the positive group and 26/47cases(55.3%)in the negative group.The incidence of Henoch-Schonlein purpura nephritis in the positive group was significantly higher than that in the negative group(P=0.038).The type of Henoch-Schonlein purpura nephritis was mostly isolated proteinuria in the two groups,and there was no significant difference in the clinical type of Henoch-Schonlein purpura nephritis in the two groups(P=0.579).(2)There were no significant differences in the clinical manifestations of abdominal pain,nausea/vomiting,abdominal distension,diarrhea,gastrointestinal bleeding,rash and joint involvement between the two groups(P>0.05).2.Laboratory examination: there was no significant difference in white blood cell count,C-reactive protein,platelet count,hemoglobin,fibrinogen,albumin,serum creatinine,urea nitrogen,uric acid and other indicators between the two groups(P>0.05).3.Imaging examination:There was no significant difference in abdominal color ultrasound/abdominal CT findings between the two groups(P>0.05),and the thickening of intestinal wall/stomach wall was the most common findings in both groups.4.Endoscopy: All the 72 children underwent endoscopy.Under endoscopy,gastric antrum mucosal lesions were most common in the positive group(25/25 cases,100.0%),while gastric body mucosal lesions were most common in the negative group(47/47 cases,100.0%).The types of mucosal lesions were mostly blotchy hyperemia,edema,erosion and erythema.Some children had mucosal ulcer and roughness,and a few children had mucosal hemorrhage and purpura-like rash.The most obvious lesions of esophageal and gastric mucosa were hyperemia and edema,and the main lesions of duodenal mucosa were erythema and erosion.There was no significant difference in the incidence of esophageal,gastric and duodenal mucosa lesions between the two groups(P>0.05).5.Mucosal biopsy: A total of 64/72 children underwent gastric and/or duodenal mucosal biopsy(19/72 in the positive group and 45/72 in the negative group).In Hp positive group,there were 10/19 cases of gastric antral mucosa biopsy,6/19 cases of duodenal mucosa biopsy,and 3/19 cases of gastric antrum and duodenal mucosa biopsy.In Hp negative group,there were 16/45 cases of gastric antral mucosa biopsy,20/45 cases of duodenal mucosa biopsy,and 9/45 cases of gastric antrum and duodenal mucosa biopsy.There were mononuclear cell infiltration in gastric antral mucosa and/or duodenal mucosa in all children,neutrophil infiltration in some cases and eosinophil infiltration in a few cases.In addition,biopsy showed hyperemia,edema,erosion,necrosis and exudation of gastric antrum mucosa or duodenal mucosa in a few children.Conclusions: 1.Hp infection may increase the incidence of Henoch-Schonlein purpura nephritis in children with HSP.2.No effects of Hp infection on digestive tract symptoms,rash severity,joint damage,laboratory indexes,abdominal color ultrasound/abdominal CT findings were found in HSP children.3.Whether active anti-Hp therapy can reduce the risk of renal damage in HSP children with Hp infection remains to be confirmed by further clinical studies. |
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