Clinical Characteristics And Related Factors Analysis Of 287 Children With IgA Vasculitis

IgA vasculitis(IgAV,formerly known as Henoch-Schonlein purpura)is a systemic small vessels vasculitis.IgA vasculitis is characterized by leukocyte infiltration of the blood vessel walls along with immunoglobulin A deposition.Its clinical manifestations are often characterized by non-thrombocytopenic purpura,abdominal pain,joint pain,and severe symptoms of gastrointestinal damage(enterorrhagid,enterobrosis and intussusception),renal damage and other organs(brain,pulmonary)damage,or even life-threatening.Some children may have different degrees,times of rash recurrence.Henoch-Schonlein purpura nephritis(HSPN)is a common complication of Henoch-Schonlein purpura.Some children have hidden early onset,and there may be normal in laboratory examination,which lead to delayed diagnosis and treatment.The process of some IgAV is prolonged,and less patients even progress to chronic renal insufficiency.The recurrence of rash and the occurrence of Henoch-Schonlein purpura nephritis affect the prognosis of children,there is no golden biomarkers to predict the occurrence of these symptoms currently.Therefore,it is of great clinical significance to explore the risk factors related to the prognosis of IgAV in children for the occurrence and development of early intervention for complications and the improvement of children's quality of life.Part one Discuss the correlation between IgA vasculitisand clinical manifestation,rash and pathologyObjective:To discuss the correlation between IgA vasculitis and clinical manifestation,rash and pathology by comparing IgAV patients' general and laboratory data.Methods:The clinical data of 287 IgAV patients who met the inclusion criteria and were hospitalized in the Department of Nephrology And immunology,Children's Hospital Soochow University from January 2018 to December 2018 were collected,including:gender,age,whether to predisposing factors,whether accompanied with joint swelling or abdominal pain,whether to have gastrointestinal bleeding,red blood cell count,hemoglobin,platelet count,D-dimer,fibrinogen,cystatin C,creatinine,urea nitrogen,complement 3,complement 4,immunoglobulin,lymphocyte subsets,urine protein spectrum,24-hour urine protein quantification.All of the patients were followed up for 6 months.IgAV clinical manifestations and prognosis of patients were compared and analyzed by statistical software.The pathological results of the children with renal biopsy were analyzed to find relevant laboratory indexes that could predict the severity of renal pathological results of the children.Results:1.There were 287 cases of IgAV,including 104 cases younger than 6 years old(36.2%)and 183 cases older than 6 years old(63.8%).The incidence of Henoch-Schonlein purpura nephritis was compared between the two groups,and the difference was significant statistically(P<0.05).2.The incidence of Henoch-Schonlein purpura nephritis in 287 IgAV patients were 33 cases with Henoch-Schonlein purpura nephritis(11.5%)and 254 cases without Henoch-Schonlein purpura nephritis(88.5%).Compared with various laboratory indicators in the two groups,the levels of serum creatinine and IgG were significant statistically(P<0.05).3.The incidence of rash recurrence in 287 IgAV patients were 59 cases with recurrence of rash(20.6%)and 228 cases without recurrence of rash(79.4%).Compared with various laboratory indicators in the two groups,serum C4 level was correlated with IgAV recurrent rash in children,with no statistically significant difference in recurrence times(P>0.05).4.The levels of IgA/Fib,Urinary albumin/creatinine(ACR)and 24-hour urine protein quantification were different in the severity of renal pathology.5.There were the higher the IgA/Fib value,the lighter the renal pathological grade and the higher the value of ACR and 24-hour urine protein,the heavier the renal pathological grade.Conclusions:1.The decrease of serum C4 level was an independent clinical risk factor for the recurrence of IgAV rash in children.2.There were the higher the IgA/Fib value,the lighter the renal pathological grade and the higher the value of ACR and 24-hour urine protein,the heavier the renal pathological grade.3.Children older than 6 years old are prone to Henoch-Schonlein purpuric nephritis in children with IgAV.Part Two Discuss the correlation between IgA vasculitis and white blood cell and their classificationObjective:To discuss the correlation between IgA vasculitis and white blood cell and their classification by comparing IgAV patients and controls according to age subgroups.Methods:On the basis of the first part,data of all 287 IgAV patients and 160 controls who were admitted to our hospital for elective at the same time were collected on the blood routine test,including for white blood cell count,neutrophil count,lymphocyte count,monocyte count,eosinophil count,basophil count.And the neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),platelet to lymphocyte ratio(PLR)were calculated.The age was divided into three groups for comparative analysis,which were divided into 0 to 4 years old,4 to 6 years old and over 6 years old.To discuss the correlation between IgA vasculitis and age,white blood cell count and their classification.Results:1.Among the three age groups,compared with the control group,N,NLR and PLR were higher and LMR were lower in IgAV group,and the differences were statistically significant(P<0.05).As age increases,the sensitivity and specificity of NLR also change in the diagnosis of IgAV.2.The clinical manifestations of 287 children with IgAV were 46 cases of simple type(16.0%),49 cases of abdominal type(17.1%),116 cases of joint type(40.4%),and 76 cases of mixed type(26.5%).Regardless of age,NLR,LMR,and PLR have some significance in comparisons of children with simple IgAV and other clinical manifestations.After comparison by age group,in the age group of 4 to 6 years of old,only NLR has some significance in comparisons of children with simple IgAV and abdominal type;in the age group of over 6 years of old,NLR,LMR,and PLR all have some significance in comparisons of children with simple IgAV and other clinical manifestations.3.Regardless of age,the differences of NLR,LMR,and PLR between the two groups with and without gastrointestinal symptoms were significant statistically in patients with IgAV.After comparison by age group,N,NLR,LMR and PLR of IgAV patients with over 6 years old were different statistically in the two groups with or without gastrointestinal symptoms(P<0.05).4.Among the three age groups,there was no significant difference in N,L,NLR,LMR,and PLR between the Henoch-Schonlein purpura nephritis and non-Henoch-Schonlein purpura nephritis groups(P>0.05).Conclusions:NLR,LMR,and PLR are related to the clinical phenotype of IgAV,and age factors need to be considered.