A Retrospective Study Of 521 Children With Henoch Schonlein Purpura

Objectives : To investigate the occurrence and development,clinical presentation,Chinese medicine syndrome differentiation and treatment and prognosis of allergic purpura in children,in order to improve the understanding of the disease and provide clinical basis for the diagnosis and treatment.Methods:Retrospective study was carried out using software Excel and SPSS20.0.It covered general pediatric inpatients admitted to the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine between December 31,2010 and December 31,2015(Yunnan Province Hospital of traditional Chinese Medicine)meeting the inclusion standard of allergic purpura in children(age,gender and disease season),predisposing factors,clinical manifestations,laboratory examination,classification,the use of traditional Chinese medicine,treatment and prognosis.Results:1.General situation: This study collected 521 cases of allergic purpura in children,the average age was(8.25 ± 2.87)years old,among which the school-age group had high incidence of the disease is(between the age of more than or equal to 7 and less than 12 years old),a total of 267 cases(51.24%).The ratio of male to female was 1.43:1.Disease has higher incidence in spring and winter,accounting for 57.97% of the year.2.Cause: Respiratory tract infection was the main cause of Henoch Schonlein purpura in children,accounting for 55.28% of the total incidence;patients with food allergy,drug allergy or other factors allergy accounted for 9.02%,7 cases with family history accounted for 1.34%;The remaining children had unknown cause.3.Clinical manifestations: 521 children with Henoch Schonlein purpura had skin purpura in in hospital,including 462 cases with skin purpura as initial symptoms;182 patients hadgastrointestinal symptoms;121 cases had joint symptoms;renal involvement appeared in 157 cases,which had no significant correlation with gastrointestinal symptoms and joint symptoms(p>0.05),age groups had high incidence(between the age of more than or equal to7 and less than 12 years old)(p<0.05).4.Laboratory examination: 215 patients had elevated white blood cell count;237 patients had C elevated CRP;187 cases had elevated platelet;69 cases had mycoplasma pneumonia positive;42 cases had Legionella pneumophila positive;37 cases had adenovirus;31 cases had respiratory syncytial disease positive;A,B or(and)side of influenza virus was positive in29 cases;6 cases had chlamydia pneumonia positive;84 cases had antistrptolysin O positive;72 cases had positive fecal occult blood;fibrinogen increased in 174 cases;two D-dimer increased in 122 cases.5.TypesClinical classification of Western medicine: 163 cases of simple purpura,abdominal purpura in 94 cases;joint type purpura in 57 cases;renal type purpura in 88 cases;mixed purpura in 119 cases.TCM Syndrome Type: 225 cases of wind heat invading collaterals;blood heat injuring collaterals in 103 cases;92 cases of damp heat invading collaterals;stomach heat retention syndrome in 59 cases;21 cases of qi deficiency and blood stasis syndrome;hyperactivity of fire due to yin deficiency in 13 cases;8 cases of spleen kidney yang deficiency.6.Chinese medicine treatment rules: Commonly used traditional Chinese medicine before ten are: licorice,Schizonepeta,windproof,red peony root,Herba cephalanoploris,mung bean,red bean,black bean,fried forsythia,honeysuckle.20 kinds of high frequency drug clustering is divided into: C1: red bean,black bean,mung bean,fried forsythia,honeysuckle,Rhizoma imperatae;C2: Atractylodes rhizome,phellodendron,buffalo,corner end Lithospermum,coix seed,Cortex Moutan,agrimony,Achyranthes,madder;C3: Herba cephalanoploris,radix paeoniae rubra,radix Saposhnikoviae;C4: licorice,mustard.Medicine with function of heat clearing and detoxifying,acrid-warm herbs relieving superficies,eliminating pathogenic heat from the blood,cooling blood and hemostasis,and Qi tonifying are most commonly used in clinic.Medicine with the function of ruling out "heat","blood stasis","poison","wind" ","wet "," weakness "and so on must be used together in the treatment.7.Treatment and prognosis: 521 cases of children with Henoch Schonlein purpura were mainly treated with traditional Chinese medicine,164 cases were treated with western medicine.After the treatment,120 cases were cured,396 cases improved,5 cases were ineffective,the total efficiency was 99.04%.Conclusion:1.Children with Henoch Schonlein purpura is often found in the school age,most of whom are male children,it had a high incidence in spring and winter.2.Respiratory tract infection is the main cause of Henoch Schonlein purpura in children.3.Characteristic skin purpura as first symptom is the most common in the clinical manifestation,followed by gastrointestinal symptoms and joint;age(between more than or equal to 7 and less than 12 years old),children with Henoch Schonlein purpura are susceptible to kidney involvement.4.Purpura simplex the most common in,western medicine,followed by mixed purpura;wind heat invading collaterals is the most common in TCM syndrome type,Qi deficiency and blood stasis syndrome,yin deficiency and fire hyperactivity syndrome and spleen kidney yang deficiency are relatively rare in western medicine.TCM syndrome,wind heat invading collaterals is the most common in western medicine,wind heat invading collaterals TCM syndrome,while purpura simplex is the most common in the western medicine which is corresponding to the syndrome of wind heat invading collaterals.5.Blood stasis is throughout the disease has always been the cause of the wind and heat evil outside the body,there are hot poison inside the body;the main pathogenesis of children with allergic purpura resulted from the vein damage and blood circulation.The wind,heat toxin and blood stasis are common in children with allergic purpura,it can be treated with dispelling wind and clearing heat and detoxicating,cooling blood to remove blood stasis Drugs with the function of heat clearing and detoxifying,acrid-warm herbs relieving superficies,eliminating pathogenic heat from the blood,cooling blood and hemostasis,and Qi tonifying are the most commonly used.Medicine with the function of ruling out "heat","blood stasis","toxin","wind" "," wet "," weakness "and so on must be used together in the treatment which complies with point of director Liu Yimin that "heat" and "blood stasis" will cause disease.6.Our hospital treated children allergic purpura with comprehensive therapy of traditional Chinese medicine decoction,Chinese medicine,Chinese medicine injection and external therapy of traditional Chinese medicine whose effect is obvious,but as for some serious abdominal purpura and purpura nephritis,combined treatment of TCM and Western medicine is still need to improve the curative effect.