| Background and objectives:Henoch-Schonlein purpura(HSP)is the most common seen vasculitis among children.According to the new classification of vasculitis,HSP belongs to non-Granulomatosis small vessel vasculitis which can be characterized by the deposition of immune complexes containing IgA in the walls of small blood vessels(small arteries,capillaries,and venules)and further induce purpura,joint inflanuuation or joint pain,abdominal pain and some kidney diseases.Because HSP has no effective treatment,one-third of cases may relapse,and 20-80%may be complicated by Henoch-Schonlein purpura nephritis,about 1%of cases may suffer irreversible kidney damage and long-term sequelae such as chronic kidney disease.The pathogenesis of HSP is still unclear.Abnormal glycosylation of IgAl molecules makes it easy for HSP patients to form large immune complexes.The removal of these macromolecules is blocked,causing them to deposit in the small blood vessel wall of the affected organs to trigger an immune response.The humoral immunity,cellular immune intervention,coagulation damage,and genetic susceptibility factors caused by genetic polymorphism may all be associated with this disease.Studies have reported that the levels of fibrinogen,D-dimers and platelets in children with HSP are significantly higher than those in healthy controls.Moreover,the proportion of HSP cases in the hypercoagulable state with renal damage is significantly higher than that in cases without renal damage,which means that the hypercoagulable state increases the risk of complicated Henoch-Schonlein purpura nephritis in children.Recent studies have confirmed that the blood coagulation cascade caused by abnormal blood coagulation mechanism and fibrinolysis system leads to hypercoagulability and thrombogenesis,and at the same time,the production and release of various cytokines,chemokines,and inflammatory mediators cause immune damage to the body,which contributes to the pathogenesis of HSP.Based on the understanding of this mechanism,this study is expected to explore a safe and reliable clinical therapy for improving the prognosis of children with Henoch-Schonlein purpura,in order to reduce the recurrence of Henoch-Schonlein purpura,reduce the incidence of Henoch-Schonlein purpura nephritis,and improve the long-term life quality for children.METHODS:A total of 158 children with Henoch-Schonlein purpura admitted by the Department of Nephrology,Children's Hospital of Soochow University from November 2016 to June 2017 were enrolled.The study used a retrospective approach.The subjects were divided into two groups according to whether urokinase was applied during hospitalization,43 cases in the observation group,115 cases in the control group,and the control group were treated with conventional drugs:all patients were supplemented with Five Vitamins and Calcium Gluconate Oral Solution,Vitamin A&D drops,Loratadine Tablets,Piperazine ferulate tablets.Those infected were treated with anti-infective therapy.Routine use of low dose methylprednisolone[1?2mg·kg-1·d-1]intravenous infusion,combined with abdominal pain and/or arthritis,the dose of methylprednisolone[2?4mg·kg-1,d-1],after the symptom relief,treatment is changed to the oral of Prednisone Acetate Tablets.After the patient was discharged from the hospital,he was followed up by the clinic and gradually reduced to the withdrawal according to the condition.The observation group administered urokinase by intravenous infusion on the basis of the control group.Age,sex,weight,blood routine,blood coagulation function,complete urine protein,liver and kidney function,humoral immunity,lymphocyte subsetsanti-streptolysin "O"(ASO),clinical classification,etc.of the children were included in the study.The ratio of male to female in the control group was 58:57;the age was ranged from 2 to 13(6.83±2.56)years old;the average body weight was 25.04±9.18 kg.All patients presented with a purpura-like rash in clinical manifestations,13cases of simple type,33cases of abdominal type,41 cases of joint type,and 28 cases were the mixed type.The ratio of male to female in the observation group was 29:14;the age was ranged from 2 to 14(6.27±2.71)years old;the average body weight was 22.86±7.56kg.All patients presented with a purpura-like rash in clinical manifestations,2cases of simple type,8cases of abdominal type,18 cases of joint type,and 15 cases were the mixed type.There were no significant differences in gender,age,weight,clinical classification and other general data between the two groups(P>0.05).There were no significant differences in laboratory parameters(such as blood routine test,coagulation function,urine protein,hepar and kidney function,humoral immunity,lymphocyte subsets,ASO level,etc.)when the two groups were admitted to the hospital(untreated).The two groups of patients were experimentally comparable.(P>0.05).All children were followed up for more than 6 months.The recurrence of Henoch-Sch6nlein purpura was compared between two groups during follow-up.The incidence of Henoch-Schonlein purpura nephritis was compared between the two groups during the follow-up period.The time of occurrence of Henoch-Schonlein purpura nephritis was compared between the two groups.Statistical analysis was performed using statistical software SPSS version 24.0.The measurement data were expressed as x±s,analyzed by t-test,and the count data were expressed as 'example/%,' using the ?2 test.P<0.05 was considered statistically significant.Result:1.The recurrence of the two groups was followed up.There were 2 cases of recurrence in the observation group,the recurrence rate was 4.7%,and a total of 24 cases of recurrence in the control group,with a recurrence rate of 20.9%.The clinical recurrence rate of the observation group was significantly lower compared to the control group,and the difference was statistically significant(?2=5.988,P=0.014<0.05).2.The incidence of Henoch-Schonlein purpura nephritis in the two groups was investigated by follow-up.There were 2 cases of Henoch-Schonlein purpura nephritis in the observation group;the incidence rate was 4.7%.And there were 21 cases had Henoch-Schonlein purpura nephritis in the control group,the incidence rate was 18.3%.The difference was statistically significant(?2=4.661,P=0.031<0.05).3.During the follow-up period,2 patients in the observation group developed Henoch-Schonlein purpura nephritis,including 1 case within six months,1 case after six months.A total of 21 patients in the control group developed Henoch-Sch6nlein purpura nephritis,of which 18 cases occurred within six months,and 3 cases occurred after six months.50%of the observation group occurred within 6 months corresponding to 85.7%in the control group.There was no significant difference in the time of occurrence of Henoch-Schonlein purpura nephritis between the two groups.(Fisher exact test,P=0.342>0.05).4.No children in the urokinase treatment group were observed to have adverse reactions such as allergies and bleeding during the treatment period.Conclusions:1.The use of urokinase in the treatment of children with first-onset HSP can reduce the probability of recurrence.2.Treatment of children with HSP with urokinase can reduce but not delay the occurrence of Henoch-Schonlein purpura nephritis. |
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