Expression And Significance Of Serum High Mobility Group Protein Box1 In Children With Henoch-sch(?)nlein Purpura And Clinical Analysis Of Coronary Artery Lesions In Children With Systemic Juvenile Idiopathic Arthritis

PART ONE: EXPRESSION AND SIGNIFICANCE OF SERUM HIGH MOBILITY GROUP PROTEIN BOX1 IN CHILDREN WITH HENOCH-SCH(?)NLEIN PURPURAObjective: To investigate the serum expression of high mobility group protein box 1(HMGB1)and its relationship with laboratory parameters in children with Henoch-Sch(?)nlein purpura(HSP),and to explore the role of HMGB1 playing on the pathogenesis of HSP.Methods: Eighty-three HSP patients newly diagnosed in Children's Hospital of Chongqing Medical University from December 2017 to December 2019 were included.The patients without renal involvement were assigned as group A,and the rest were as group B.Eighteen HSP patients in remission were involved in as group C and twenty healthy children were as healthy controls.Serum HMGB1 levels were measured by enzyme-linked immunosorbent assay and were compared among group A,B,and C,D and among children with different degrees of renal damage.The correlations between serum HMGB1 and laboratory parameters in HSP patients were analyzed.Results: 1.The serum level of HMGB1 in group A,B,C and D was 10.7(6.8~16.0)ng/ml,13.8(10.0~22.7)ng/ml,7.6(5.7~10.8)ng/ml,5.0(4.0~5.4)ng/ml,respectively.The difference in serum HMGB1 levels between group A and B,group A and C,group A and D was statistically significant(P<0.05).2.Serum HMGB1 level in children with solitary hematuria,solitary proteinuria,hematuria and proteinuria was 11.0(8.1~16.4)ng/ml,12.8(8.5~20.9)ng/ml,17.4(13.0~27.8)ng/ml,respectively.There was no significant difference in serum HMGB1 levels among the three groups(P>0.05).3.Serum HMGB1 level was linearly positively correlated with white blood cell count,neutrophil percentage,serum IgA,d-dimer,urine addis red blood cell count,24-hour urine protein quantification and negatively correlated with the percentage of lymphocytes(P<0.05).4.The area under the ROC curve of Henoch-Sch(?)nlein purpura nephritis(HSPN)diagnosed by serum HMGB1 was 0.961(95%CI:0.908~1.00,P<0.001).The cut-off value was 7.29ng/ml,the sensitivity was 89.5% and specificity was 100%.Conclusions: The expression of serum HMGB1 is related to renal damage in HSP patients.HMGB1 may be involved in the pathogenesis of HSP and HSPN,and has the potential to be a serological marker for HSPN.PART TWO: CLINICAL ANALYSIS OF CORONARY ARTERY LESIONS IN CHILDREN WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITISObjective: To analyze the clinical characteristics of systemic juvenile idiopathic arthritis(SJIA)patients with coronary artery lesions(CAL),and the short-term prognosis of CAL in SJIA patients.Methods: Clinical data on 96 SJIA patients who were newly diagnosed at the Children's Hospital of Chongqing Medical University from December 2014 to December 2019 and accepted coronary artery assessment were reviewed retrospectively.25 patients with CAL were divided into CAL group and the remainders were as non-CAL group.36 patients initially misdiagnosed as Kawasaki disease(KD)or incomplete KD(IKD)were assigned as presumed KD(p KD)group and the remainders were as non-p KD group.The clinical characteristics of the two pairs were compared,respectively.Results: 25 of 96 children with SJIA had CAL(26.04%),the ratio of male to female was 1: 1.27,and the median age was 5.0(2.5~9.4)years.Four of them(16.00%)had dilated coronary arteries,and 21(84.00%)had small coronary aneurysms.Other clinical manifestations included evanescent rashes(21,84.00%),serositis(15,60.00%),arthritis(14,56.00%),cervical lymphadenopathy(15,60.00%),hepatosplenomegaly(13,52.00%).There was no significant difference in WBC,PLT,N%,CRP,PCT,ESR between CAL group and non-CAL group(P>0.05).There was no statistically significant difference in the Z score between the left main coronary artery(LMCA)and right coronary artery(RCA)(P>0.05)in the early stage.After 6 months,both the Z score of LMCA and RCA was significantly lower than that of the initial diagnosis(P<0.05).The p KD group(n=36)all received IVIG treatment(1~2g/kg.per dose),but they still had repeated fever.The ratio of rashes,bayberry tongue,changes of extremities,CAL in p KD group was significantly higher than that in non-p KD group(P<0.05).However,the age of onset and the ratio of arthritis in p KD group was lower than that in non-p KD group(n=60)(P<0.05).Conclusions: 1.The early clinical characteristics of SJIA are similar to KD,the SJIA patients who are relatively young,with typical KD manifestations,and lack of joint symptoms are likely to be misdiagnosed as KD,especially IKD.2.SJIA patients can present with CAL in the early stage and small coronary aneurysm is the main form of the CAL.Most of the CAL improved after 6 months of onset.In practice,it is recommended to conduct echocardiographic evaluation of coronary arteries in SJIA patients in the early stage.3.For IVIG non-responsive KD or IKD,it is necessary to be highly vigilant for other inflammatory diseases.