Clinical Analysis Of 604 Children With Henoch Schonlein Purpura

Objective To explore the pathogenesis,clinical manifestations,laboratory indicators,clinical treatment and prognosis of children with allergic purpura,and to improve the understanding of the disease,so as to provide evidence and guidance for the prevention,diagnosis and treatment of children with allergic purpura.Methods This study adopted the methods of literature review,eomparative analysis and mathematical analysis,combined with the author's internship and work experience in Children's Hospital Affiliated to Suzhou University.While gaining the support of hospital supervisors,and considering the treatment stage and time limit of new children with HSP,we chose September 2016.The clinical data of 604 hospitalized children with HSP received by the Rheumatology and Immunology Department of Children's Hospital Affiliated to Suzhou University from August 2017 were analyzed systematically.The age,inducement,clinical symptoms,laboratory examination,sex and treatment of HSP were selected as quantitative analysis indicators,and the data were analyzed by EXCEL and SPSS.17 the software enteResult:1)A total of 604 children with Henoch-Schonlein purpura were collected in this study.The youngest age was 2 years old,the oldest age was 13 years old,and the average age was 6.69 years old.There were 324 males(53.6%)and 280 females(46.4%).The ratio of males to females was 1.14:1.2)Etiology and inducement:244 of 604 children had definite etiology before onset,of which 184 had a history of upper respiratory tract infection within 2 weeks before onset,accounting for 30.4%;2 had pneumonia,accounting for 0.3%;48 had food allergy,accounting for 7.9%;before onset,there were seafood,egg yolk,soybean,milk and other products;6 had urinary tract infection(1%)and flowers.2 cases were allergic to powder and 2 cases were induced by vaceination.Of the upper respiratory tract infections,there were 108 males and 76 females.There were 20 males and 28 females with food allergy.Among 95 children with HSP and HSPN re-admitted to hospital,there were 32 cases of upper respiratory tract infection,accounting for 33.6%of re-admitted eases,11 eases of food allergy(11.5%).Food allergy was mainly seafood,other high-protein foods,soybean products and other high-protein foods,2 cases of tropical fruits,and 4 eases of inappropriate hormone reduction(4.2%).3)Clinical manifestations:There were 196 cases of joint symptoms in 604 children,42 cases(21.4%)in infants and preschool age group,137 cases(69.8%)in school age group and 8.6%in adolescence group.The joint of school age children was more vulnerable to injury(p<0.05).Typical purpura rash occurred in 572 of 604 children.14 children were admitted to hospital with hematemesis and abdominal pain,and confirmed by gastroscopy.Among 604 cases,164 cases(27%)had gastrointestinal symptoms,98 cases(16.5%)had both joint symptoms and gastrointestinal symptoms,and 12 cases were admitted to hospital for abnormal urine examination due to past history of allergic purpura.4)renal damage:168 children(27.8%)had Henoch Schonlein purpura nephritis in 604 children with Henoch Schonlein purpura.Among 168 cases of purpuric nephritis,72 were male and 96 were female.The ratio of male to female was about 1:1.3.Among 168 cases of Henoch-Schonlein purpura nephritis,39 cases(23.2%)had joint symptoms,49 cases(29.1%)had digestive tract symptoms,and 52 cases(30.9%)had joint symptoms and digestive tract symptoms.The kidneys of children with purpura and gastrointestinal symptoms are more susceptible.5)Clinical and pathological types of Henoch-Schonlein purpura nephritis:168 children with Henoch-Schonlein purpura nephritis,48 of them underwent renal biopsy.Among them,23 cases(47.9%)were hematuria and proteinuria,3 cases(6.25%)were acute nephritis,1 case(2.1%)was acute nephritis,6 cases(12.5%)were nephrotic syndrome,14 cases(29.1%)were isolated hematuria or isolated proteinuria,and 1 case(2.1%)was chronic nephritis.The pathological grading of 48 cases of glomerulus was grade ? B in 14 cases(29.1%)Fig.1,grade ? a in 11 cases(20.9%),grade ? in 8 cases(16.6%),grade ? in 8 cases(16.6%)Fig.2,grade ? in 7 cases(14.6%)and Fig.3.There were no cases of grade I,grade V and grade vi.78%(22/28)of isolated hematuria or proteinuria was pathological grade ?.Hematuria and proteinuria pathology were found in grade ? and ?,accounting for 52%(12/23)and 43.4%(10/23)respectively.Acute glomerulonephritis was mainly classified as grade ? B(67%(2/3),nephrotie syndrome was mainly classified as grade ? and IV(50%(3/6)and 50%(3/6),respectively.One case of acute glomerulonephrMtis was classified as grade IV B.1 cases of chronic glomerulonephritis were grade ? B.Isolated hematuria or albuminuria were found in I cases with patibology of IV B and 1 cases of chronic nephritis as grade ? B.The clinical types of Henoch Schonlein purpura nephritis are basically the same as those of the kidney,but they are not completely parallel.6)IgA level:Among 604 children with Henoch-Schonlein purpura,184(30.4%)had elevated blood IgA level,112(60.8%)in Henoch-Schonlein purpura nephritis group and 72(39.2%)in non-Henoch-Schonlein purpura nephritis group.The level of IgA was closely related to renal injury,and P<0.05 was statistically different.Conclusion 1.Upper respiratory tract infection is a common inducement in children with allergic purpura.2,allergic purpura whose first symptom is gastrointestinal symptoms is prone to misdiagnosis.3.Children with Henoch Schonlein purpura are more susceptible to kidney damage due to elevated IgA and gastrointestinal symptoms.4.Purpura nephritis is basically the same as that of renal pathology,but it is not completely parallel.