| Objective: The study explores the differences between adults and children in Henoch-Sch?nlein purpura in terms of epidemiological characteristics,clinical manifestations,laboratory indicators,imaging and digestive endoscopy,renal histopathology,and treatment,and analysis of related risk factors for renal damage in patients with Henoch-Sch?nlein purpura.Improve awareness of the clinical characteristics of Henoch-Sch?nlein purpura in adults and children and help guide clinical work.Methods: Collect medical records of patients with Henoch-Sch?nlein who were hospitalized in dermatology,pediatrics,gastroenterology,and nephrology of our hospital from January 2017 to December 2018.316 patients with Henoch-Sch?nlein who met the inclusion and exclusion criteria were screened.They were divided into two groups according to age: children(age <18 years)and adults(age ? 18 years).The medical records of children(253 cases)and adults(108 cases)were retrospectively analyzed,and the two groups were compared.Patients differed in general conditions and epidemiological characteristics,clinical symptoms and signs,laboratory examinations,imaging and endoscopy,histopathological examinations,and treatment.Divided according to whether there is kidney damage: kidney damage group(141 cases)and non-renal damage group(148 cases),univariate contrast analysis of the general situation and epidemiological characteristics,clinical manifestations and laboratory tests of the two groups,and screen out The differences were statistically significant.Multivariate logistic regression was used to analyze the risk factors of renal damage.Results:1.General situation and epidemiological characteristics: The ratio of children to adults is 2.3 : 1.Both groups are slightly more male than females,57.7% males in children and 53.7% males in adults.The onset season is most common in autumn and winter.The highest percentage in children is 30.0% in autumn,and the highest in adult group is 37.0% in winter.Upper respiratory tract infections were the most common of the possible causes in both groups,with 31.2% of pediatric patients and 23.1% of adult patients having a previous history of onset.2.Clinical characteristics: Rash is the most common first symptom.Purpura is the first symptom in 82.2% of children and 89.8% of adults.Gastrointestinal symptoms developed in 12.6% of children and 8.3% of adults.Symptoms of joint onset and urinary symptoms are rare,especially one child with onset of scrotal pain.In clinical classification,the mixed type was the most common in both groups,and 39.5% of the children and 38.9% of the adult groups were mixed.15.8% of children and 7.4% of adults were simple,17.8% of children and 12.0% of adults were abdominal,15.8% of children and 4.6% of adults were articular,11.1% of children and 37.0% of adults were of kidney type.Gastrointestinal symptoms occurred in 53.4% of pediatric patients and 35.2% of adult patients.Joint symptoms occurred in 42.3% of pediatric patients and 36.1% of adult patients.Kidney damage occurred in 33.6% of pediatric patients and 74.1% of adult patients.Among them,the difference between gastrointestinal symptoms and kidney damage in the two groups was statistically significant(P < 0.05).There was no significant difference in the degree of purpura injury score between the two groups of patients(P > 0.05),and the difference in the area of purpura involvement was statistically significant(P < 0.05).Children with gastrointestinal involvement were more likely to have nausea and vomiting than adults,and the difference was statistically significant(P < 0.05).Among patients with renal impairment,adults were more likely to have kidney-related hypertension than children,and the difference was statistically significant(P < 0.05).In patients with joint symptoms,the difference in specific joint symptoms(joint pain,joint swelling,joint swelling and pain)is statistically significant(P < 0.05).In affected areas,adults are more likely to have knee involvement than children,and children are more likely to be affected than adults.Ankle involvement is more likely to occur,and the difference between the two groups is statistically significant(P < 0.05).3.Laboratory examination: Increased WBC(45.8% in children group,34.3% in adult group),PLT(52.2% in children group,13.0% in adult group),IgA(32.5% in children group,19.4% in adult group),and ASO(20.7% in children group,9.7% in adult group)were more common in children than in adults,and the difference between the two groups was statistically significant(P < 0.05).Adults had lower albumin(29.2% in children,53.7% in adults),microscopic hematuria(27.3% in children,61.6% in adults),proteinuria(30.4% in children,69.4% in adults),positive autoimmune antibodies(15.5% in children,32.2% in adults),and Helicobacter pylori infection(46.6% in children,90.0% in adults),which were more common than those in children.The differences between the two groups were statistically significant(P < 0.05).4.Histopathological examination: The pathological grades of both groups were grade III(56.3% in children,64.9% in adults),and IgA + IgM deposition(68.8% in children,54.1% in adults)were the most common immunopathology.There was no significant difference in the pathological grade and immunofluorescence typing of kidney tissue between the two groups(P > 0.05).5.Treatment: In the treatment plan,the children group chose more systematic use of glucocorticoids,antihistamines,dipyridamole,rutin tablets,antibiotics,and the adult group chose more topical glucocorticoid ointments.The difference was statistically significant(P < 0.05).In children,purpura mostly resolves within one week after admission,and in adults,purpura resolves more than one week after admission.The difference was statistically significant(P < 0.05).6.Risk factors for kidney damage: In the univariate analysis of risk factors related to HSP kidney damage,there were statistically significant differences in age over 18 years,length of hospital stay,time required to resolve purpura,history of upper respiratory infections,recurrence,degree of purpura injury,joint symptoms,and platelet count.Further multivariate logistic regression analysis showed that the age was greater than 18 years(OR = 5.138),the length of hospital stay(OR = 1.094),the time required to resolve purpura after admission(OR = 3.137),and the recurrence(OR = 5.454)was HSP idependent risk factor for kidney damage in patients.Conclusion:1.Henoch-Sch?nlein purpura is common in children,males are more common in females,and they occur frequently in autumn and winter.Upper respiratory tract infections are the most common possible cause.2.Rash is the most common first symptom of Henoch-Sch?nlein purpura.Mixed type is the most common clinical type of Henoch-Sch?nlein purpura.Children are more likely to have gastrointestinal symptoms and adults are more likely to have kidney damage.3.Children and adults with Henoch-Sch?nlein purpura have certain differences in laboratory tests such as WBC,PLT,IgA,ASO,serum albumin,microscopic hematuria,proteinuria,autoimmune antibodies,and H.pylori infection.4.In kidney biopsies of patients with Henoch-Sch?nlein purpura with kidney damage,IgA deposition was seen in almost all patients with immunofluorescence,and C3 deposition was seen in most cases.The pathological grade of patients with Henoch-Sch?nlein purpura is the most common grade III,and the immunopathology is the most common type of IgA + IgM deposition.Kidney pathological biopsy is necessary for adult patients with persistent renal impairment.5.Age over 18 years,length of hospital stay,purpura regression time greater than one week,and recurrent episodes are independent risk factors for kidney damage in HSP patients. |
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