| Background: Henoch-Schonlein purpura(HSP)is a common acute self-limited vasculitis in children,with rash,abdominal pain,arthralgia and other systemic manifestations.However,the relationship between acute serum immunoglobulin levels and disease activity,recurrence/recurrence,and renal involvement in children with HSP remains unclear,and few studies have been conducted to investigate this correlation.Methods: 1683 Chinese children with HSP were recruited from January 2015 to January 2021.The diagnosis was established in the light of diagnostic criteria of HSP formulated by European League Against Rheumatism in 2010.None of patients had received glucocorticoids and immunosupressants in one month before hospitalization.According to the serum immunoglobulin level reference in Zhufutang practical pediatrics,all the patients were divided into elevated group,normal group and decreased group.The disease activity of HSP was evaluated according to the Birmingham Vasculitis Activity Score,version 3(BVAS-3).According to the presence or absence disease activity,relapse/recurrence and kidney involvement,they were divided into relapse/recurrence group and no relapse/recurrence group,disease activity group and no disease activity group,kidney involvement group(Henoch-Sch(?)nlein purpura nephritis)and no kidney involvement group.Serum samples were obtained from peripheral vein of all subjects in the morning after overnight fasting.52 cases with HSP nephritis(HSPN)were subjected to renal biopsy.The specimens were stained with hematoxylin and eosin,periodic Acid-schiff,and Schiff-methenamine silver and examined by light microscopy.Renal biopsy specimens were graded based on the established International Study for Kidneys Disease in Children(ISKDC)classification.Based on the above groupings and findings of biopsy,the differences in clinical manifestations and laboratory test results between the groups were compared,and p<0.05 indicated statistical significance.Results:(1)Ig A and Ig E were dramatically elevated in HSP patients as compared with their normal values,and subject to a 1.75-3.09 fold and a 1.97-2.61 fold increase,respectively.(2)No significant correlation of the disease activity with Ig A(r=0.046,p=0.106)and Ig E(r=0.047,p=0.103)was determined,respectively.(3)The serum Ig A levels were significantly lower in patients with relapse/recurrence than that in patients without relapse/recurrence(2.06±0.91g/L vs.2.17±0.87g/L,p=0.025),which may be attributed to the transmission of Ig A-mediated immune complexes from blood to vessel walls.(4)The biopsy findings according to the ISKDC were as follows: class II: 42.3%;IIIa:17.3%;IIIb: 40.4%.By immunofluorescence,the hallmark of HSPN consisted of diffuse mesangial deposition of Ig A,and to some extent,co-deposition of kappa(73.1%),lambda(71.2%)and C3(55.8%).No significant correlation was found between serum Ig A(r=-0.088,p=0.548),Ig E(r=-0.245,p=0.097)levels and the pathological classification.Conclusions: HSP children have marked disorders of serum immunoglobulin profiles,characterized by significant increases in Ig A and Ig E.The detection of serum Ig A may be applicable to predict relapse/recurrence of HSP,whereas not associated with disease activity and renal involvement. |
PDF Full Text Request