| Objective: Allergic purpura, another name is Henoch-Schonlein purpura(HSP), it is a common systemic vasculitis syndrome in childhood which pathological changes is polyangitis. HSP can offend a multitude of system. HSP caused by deposition of Ig A immune complex in small vessel wall, it can damage the skin, the joins, the abdomen, the kidney, the testis and the brain et al. The main clinical manifestation of HSP is special rash, usually following hematemesis, abdominal pain, hematochezia, arthralgia, hydrops articuli, hematuria and proteinuria, a few children have dizziness, headache, drowsiness and the swelling and pain of testis. 200 years ago, Herberdon discovered HSP from two boy, after successful treating, the report of HSP growing rapidly, so the understanding of HSP gradually deepened.Although the researchers study very hard to find the etiology and pathogenesis of HSP, but they still unknown. Clinical experts consider the possible pathogenesis is unclear pathogen infection, insect bites, inoculation or food allergens, influences the individual in genetic background, therefore, causes abnormal immune response resulting in increasing abnormally of immune complex A, it activate complement and deposit on the small vessels wall. Opinions varies on the relevant pathogens, which including mycoplasma pneumonia, bacteria and virus. Hemolytic streptococcus is the major bacteria in most reports about HSP, recent year, the report of HSP caused by EBV, mycoplasma pneumonia and helicobacter pylori appears one by one. We research the relevant pathogen hardly and give them target treatment positively, hoping to shorten the course of HSP and reduce the damage of each organ, especially ren.Whether ren be damaged or not play a key role in the prognosis of HSP. The clinical feature of Henoch-Schonlein purpura nephritis(HSPN) is single proteinuria or hematuria, proteinuria and hematuria. HSPN usually develops in 2-4 weeks after HSP occurred, it also can developing later than 4 weeks. Kidney damage sometimes is the first symptom in the HSP course. 18%-81% HSP patients have a good prognosis according to the longtime follow-up. The only dependent factor of depending the long-term prognosis is a nephritic state >3 month. A nephritic state >3 month lead to a poor outcome, while it <3 month predicting a good outcome. Research the condition of proteinuria and hematuria in the course of 3 month, to find whether the kind of pathogen can or not influence the level of proteinuria and hematuria, so we can evaluate prognosis early.Methods:1 The research object:(1) Observation group: We choose 40 HSP patient randomly from the patients who received initial treatment in pediatric Hebei medical university second hospital from 2014 January to 2014 June. The diagnosis of HSP based on the standard of “Zhu Fu Tang practical pediatrics”. Meeting two of the following standards can be diagnosed:(1) Tangibility purpura;(2)The age of onset bellow twenty years old;(3)acute bellyache;(4)Histological section showed neutrophilic granulocyte in small vein or small artery. Diagnosis standard of HSPN: hematuria and(or) proteinuria appears in the course of the disease on the basis of allergic purpura in 6 months, meanwhile exclusion of Ig A nephropathy, glomerulonephritis caused by hepatitis b virus, thrombocytopenic purpura, systemic lupus erythematosus(SLE) and so on.(2)Control group: chose 38 chilren who received healthy examination randomly.2 Research methods: Before treating, we test ASO, MP and EBV-DNA for all children in both observation group and control group. Observe and write down the number of infected children, and investigate HSP children for 6 month, further more, record the number of HSPN. According to whether children were infected, we can divide the observation group to two groups: infection and non-infection group, so record the number of HSPN children. We divided the observation to three groups according to the different pathogen, such as GAS, MP, EBV, and record the number of HSPN children and numerical value of hematuria and 24 h proteinuria in three month.3 Statistical analysis: using SPSS Statistics 13.0 software for data statistics, description and statistical analysis of data. Select P<0.05 for statistical significance. Using the chi-square test of fourfold table and rank-sum test of ranked data for two independent samples.Results:1 Researching data: 120 initial treatment HSP children, 38 healthy children. In the observation group, there are 63 boys and 51 girls, the boy to girl ratio is 1.21:1, meanwhile in the control group, there are 19 boys and 19 girls, the boy to girl ratio is 1:1. The age ranged from 3 years to 13 years in both groups, the average age of HSP and healthy children is 7.79±2.90 and 7.63±2.88, the difference of age in both groups is non-statistics significance. 114 HSP children were finished follow-up, 6 children were lost(5%).2 Result of statistics analyze:2.1 The total infection rate is 69.30%, while the rate of single GAS, MP, EBV and mixed infection is 15.19%, 41.78%, 11.39%, 31.65%.Therefore, we learn that the major pathogen is MP and mixed pathogen. Compared the disease incidence of the two group, P<0.05, indicate that infection can be related to HSP.2.2 After research the relationship of GAS, MP, EBV and HSP one by one, we know P<0.05. There is statistical significance in each both groups.2.3 28.95% HSP patients may lead to HSPN, 84.85% HSPN patients can infect the three pathogen, 15.15% HSPN patients have not the three pathogen. It has statistical significance after we have researched the relationship of the three pathogen infection and HSPN.2.4 It has statistical significance after researching the relationship of mobility rate of HSPN after infecting GAS and MP. The research indicate that the HSPN combined GAS infection attack rate is higher than that combined MP.2.5 To analyze the level of hematuria and proteinuria for all the HSPN patients, indicate that it has statistic significance and indicate that the HSPN patients who combined MP is more serious than the HSPN patients who combined GAS.2.6 Compared the duration of proteinuria of HSPN patients, we can understand that the persistence time of HSPN patients combined MP is longer than the HSPN combined GAS.Conclusions:1 HSP is relevant to the infection of GAS, MP and EBV.2 The onset of HSPN is related to infecting the three pathogens, the HSPN combined GAS infection attack rate is higher than that combined MP.3 HSPN patients who combined MP lead to serious pathogenetic condition and long pathogenesis. |
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