Changes In The Clinical Characteristics In Children With Henoch-sch(o|¨)nlein Purpura Over A5-year Period And Prognostic Factors

Background and ObjectiveHenoch-Sch nlein Purpura (HSP) is the most common rheumatic immune diseasesamong hospitalised children in recent years. Some children suffer from repeated attackwith poor prognosis. The severity of nephritis is the main factor affecting the long-termprognosis of HSP. In order to further elaborate the incidence of HSP in recent years, thechanges in the clinical manifestation and prognostic factors and improve early diagnosisand treatment, we have examined clinical features and prognostic factors in allhospitalized children with HSP of our department over the past five years and subjectedthem to systematic analysis.Research Subjects and MethodsOur study object were children discharged with a diagnosis of HSP from ourdepartment between Jan2005and Dec2002. Cinical data and follow-up data includinggender, age, seasonal occurrence, predisposing factors, clinical manifestation,laboratory examination, factors influencing prognosis were collected by reviewingmedical charts. The statistical analyses were performed using the SPSS softwarepackage (SPSS11.0; Chicago, IL). The t-test, χ~2test were used to identify the differenceamong the groups. Trend χ~2test analysis were performed to examine the change ofannual kidney involvement rate in HSP. The risk factors of renal involvement of HSPwas analyzed applying Multivariate logistic regression method.Results (1) From2006to2010，the number of hospitalized children with HSP was105162,200,208,214respectively, which showed an increasing trend. The age range ofonset of all the887children with HSP were2to16years old with the average age8.48±2.91years old. The outbreak of HSP occurred mainly in winter and spring;47.1%ofthe patients revealed predisposing factors before the onset of HSP; Compared with thedata of901HSP cases collected from1995to2005, no significant difference wasdetected with respect to the age of onset, predisposing factors and incidence of theseason rates.(2) χ~2-Test was applied to test the proportion of purpura, joint involvement,gastrointestinal involvement and renal involvement between them,but no significantdifference was revealed. However, the proportion of children with gastrointestinalinvolvement as the first symptoms increased significantly (P＜0.05).(3) Form2006to2010, the prevalence rate of renal involvement with HSP was41.9%,36.8%,31.8%,26.9%and33.3%respectively. We found a downward trend inTrend χ~2analysis (P=0.034).(4) Univariate analyses of the risk factors related to renal involvement of HSPshowed the following factor related with renal involvement significantly, includingchildren over6years old, severe purpura, occurrence of purpura（more than3in threemonths,）gastrointestinal bleeding, WBC counts increase (more than10×10~9/L)，PLTcount increase（morethan300×10~9/L）, elevated CRP and ALT；Among them,multivariate analysis indicated that “children over6years old”,“severe purpura”,“occurrence of purpura（more than3in three months）”，and“gastrointestinal bleeding”were high risk factors of renal involvement.Conclusion(1) Form2006to2010, the number of HSP cases hospitalized in our departmentwas on the rise and displayed a trend of ascend.(2) The proportion of children whosuffered HSP with gastrointestinal involvement as the initial manifestation increasedsignificantly increased significantly.(3)“children over6years”,“severe purpura”, “occurrence of purpura （more than3in three months）”, and”gastrointestinalbleeding”were high risk factors of renal involvement.