Clinical Analysis Of 110 Cases Of Henoch-Sch?nlein Purpura Associated With Streptococcal Infection In Children

Objective:To investigate the clinical characteristics of children with Henoch-Schonlein purpura associated with streptococcal infection,in order to further guide clinicians in rational treatment and improve prognosis.Methods:A total of 697 children with Henoch-Schonlein purpura(HSP)diagnosed and treated in the Department of Rheumatology and Immunology of the Children's Hospital of****from January 2019 to December 2019 were collected,and a total of 110 children with HSP related to streptococcal infection were screened as the streptococcal-infection-related HSP group(group S-HSP),a total of 315 children with HSP who had no clear pathogen infection and/or no infection manifestation in this period were classified as non-infected HSP group(group N-HSP)as Control.They were divided into streptococcus infection-related Henoch-Schonlein purpura nephritis(HSPN)group(group S-HSPN)and non-infection of HSPN group(group N-HSPN).By collecting and recording general information(age,gender,time of admission),clinical manifestations(rash,joint involvement,gastrointestinal involvement,kidney involvement and duration of rash,arthralgia,abdominal pain of all children,laboratory examination(ASO,IgA,IgG,IgM,complement C3,complement C4,urine routine,urine protein profile,24-hour urine protein quantification,serum creatinine,blood urea nitrogen,cystatin C),pathological results of renal puncture,etc.To compare the differences in general information,clinical manifestations,and laboratory test results between children with group S-HSP and group N-HSP,and to compare the clinical classification of HSPN,laboratory indicators of renal impairment,and pathological results of HSPN between the group S-HSPN and group N-HSPN.SPSS 25.0 statistical software was used for data processing and statistical analysis.P<0.05 was statistically significant.Results:1.Comparison of clinical characteristics of HSP children in streptococcus infection group and non-infection group:1.1 general information:a total of 697 children with HSP were included in this study,110 in the group S-HSP(accounting for 15.78%)and 315 in the group N-HSP(accounting for 45.19%).In the group S-HSP,there were 74 boys and 36 girls with a male-female ratio of 2.06:1.In the group N-HSP,there were 167 boys and 148 girls with a male-female ratio of 1.13:1.The male-female ratio in the group S-HSP was higher than that in the group N-HSP.The gender difference was statistically significant between the two groups(P<0.05).The average age of onset in the group S-HSP was(8.29�2.36)years old,and the average age of onset in the group N-HSP was(7.51�2.94)years old.There was a statistically significant difference in age between the two groups(P<0.05).Children in both groups can develop the disease in all seasons.The peak incidence of winter in the S-HSP group is winter and spring,and the peak incidence of autumn in the N-HSP group.1.2 clinical manifestations:In terms of clinical symptoms and duration,the incidence of joint involvement in the group S-HSP was significantly higher than that in the group N-HSP,and the difference was statistically significant(P<0.05).However,in the incidence of rash,digestive tract involvement,and the persistence of clinical symptoms In comparison of time,there was no significant difference between the two groups(all P>0.05).In terms of concurrent HSPN,the difference between the group S-HSP and the group N-HSP was statistically significant(P<0.05).1.3 laboratory examination:compared with the group N-HSP,serum C3 and C4 of the group S-HSP decreased significantly,IgA and IgG increased significantly(all P<0.05),while IgM had no significant difference between the two groups(all P>0.05).2.Comparison of renal damage degree between streptococcus infection related HSPN group and non-infection HSPN group:there was no significant difference between the two groups in clinical classification,renal damage index(blood urea nitrogen,serum creatinine,Cystatin C,24-hour urine protein quantitative)and pathological grade(all P>0.05).Conclusion:1.Streptococcal infection is a common cause of Henoch Schonlein purpura in children.Henoch-Schonlein purpura associated with streptococcal infection tends to occur in winter and spring and is more common in older boys.2.Henoch-Schonlein purpura associated with streptococcal infection compared with non-infectious Henoch Schonlein purpura,the incidence of joint involvement and kidney damage is higher,but the degree of kidney damage has not significantly increased.3.Compared with non infective Henoch Schonlein purpura,the serum complement C3 and C4 decreased significantly,and IgA and IgG increased significantly.