Clinical significance of serum gastrin, C-reactive protein and D-dimer in Henoch-Schönlein purpura children with abdominal symptoms / 中华实用儿科临床杂志

Objective@#To investigate the clinical significance of serum gastrin-17, C-reactive protein (CRP) and D-dimer (D-D) levels in early diagnosis and severity evaluation of Henoch-Schölein purpura (HSP) children with abdominal symptoms.@*Methods@#Retrospective analysis was performed in 120 children with initial HSP admitted to the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University from December 2016 to December 2017, among them, there were 70 cases with abdominal symptoms, and 50 patients without abdominal symptoms.And 20 healthy children who underwent health consultation at the First Affiliated Hospital of Anhui Medical University were selected as a healthy control group.Serum gastrin-17, CRP and D-D levels in acute phase in the HSP children were detected, and the correlation between these parameters and purpura symptom scores was analyzed.Together with gastroscope, the severity of HSP with abdominal symptoms was evaluated.@*Results@#(1) Serum gastrin-17 level in HSP children with abdominal symptoms were obviously lower than that of the other of type HSP group and the healthy control group [(3.12±1.64) pmol/L vs.(6.85±1.28) pmol/L and (7.15±1.03) pmol/L], and the differences were statistically significant (all P<0.001); the levels were decreased most significantly in HSP children with early gastrointestinal symptoms [(1.77±0.50) pmol/L vs.(4.01±1.51) pmol/L], and the difference was statistically significant (P<0.001); the pathological changes under gastroscope were obvious in HSP children with early gastrointestinal symptoms (χ2=8.095 2, P<0.05). (2) Serum CRP and D-D levels in the HSP children with abdo-minal symptoms were striking higher than those in the healthy control group [(18.39±4.48) mg/L vs.(3.95±1.65) mg/L; (2.53±1.17) mg/L vs.(0.59±0.41) mg/L], and the differences were statistically significant (all P<0.001), which were both increased most significantly in the HSP children with early gastrointestinal symptoms [(19.98±5.45) mg/L vs.(17.33±3.37) mg/L; (3.48±0.96) mg/L vs.(1.89±0.80) mg/L], and the diffe-rences were statistically significant (all P<0.05). (3) Serum gastrin-17 level was negatively correlated with purpura symptom scores (r=-0.907, P<0.01); serum CRP and D-D levels were both positively correlated with purpura symptom scores (r=0.974, 0.928, all P<0.01).@*Conclusions@#Serum gastrin-17, CRP and D-D levels in acute phase can be used as serological markers for early diagnosis of HSP children with abdominal symptoms, especially in HSP children with early gastrointestinal symptoms.

Henoch-Schönlein purpura in adults in the emergency department

A report of an unusual and easily missed diagnosis of Henoch-Schonlein purpura in an adult Caucasian male who presented in the emergency department. The patient had widespread rashes, positive urine dipstick (haematuria, proteinuria and ketonuria) and responded well to steroid and fluids treatment in the emergency department. He was admitted to the acute medical unit.

The clinical characteristics of adult abdominal type Henoch Scholein purpura / 中国综合临床

ObjectiveTo summarize the clinical features of adult patients with abdominal type Henoch Scholein Purpura(HSP) to improve the early diagnosis and therapeutic outcome of HSP.Methods The clinical features of 31 adult patients with abdominal type HSP from the Hematology department of Handan First Hospital between March 2007 to June 2010 were retrospectively reviewed and compared with that of 30 adult patients with non-abdominal type HSP.Results All the 31 patients had abdominal pain.Of those patients,48.4％ had periumbilical colicky pain, 38.7％ had whole abdominal pain and 12.9％ had lower abdominal pain.The other clinical manifestations included nausea/vomiting(19.4％),positive feces occult blood test(45.1％) .EGD and Colonoscopy of 13 patients showed mucosal congestion, red macda, erosion and ulceration mainly in the descending duodenum, distal ileum and rectosigmoid.There was no difference in age, gender, allergic history and predisposing infection between those with abdominal pain and without.The patients with abdominal pain had more cases of mixed-type HSP than those without and the difference was significant (P ＜ 0.01) .Conclusion Patients with abdominal-type of HSP are mainly young adults.So we must be more alert to abdominal-type of HSP when facing young patients with abdominal emergency.Abdominal-pain-manifesting HSP patients are mostly mixed-type cases.Gastrointestinal endoscopy is specific and might provide valuable clues for early diagnosis.

Transforming growth factor-beta gene promoter polymorphism:its association with renal involvement in Henoch-Scholein Purpura in childhood / 소아과

Purpose: Several cytokines play important roles in the inflammatory process of Henoch-Scholein Purpura (HSP). It is likely that transforming growth factor-beta (TGF-beta) is involved in the pathogenesis of HSP. The purpose of this study is to investigate whether TGF-beta promoter polymorphism is associated with the renal involvement of childhood HSP. Methods: Thirty-four patients younger than 15 years, who had been diagnosed with HSP, as well as 27 controls, were examined. Patients and controls were genotyped for TGF-beta C-509T by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The T allelic frequencies in patients and controls showed no difference (45% vs. 48.8%). No allele or genotype differences between the group of HSP group and control group were observed. The frequencies of TGF-beta 509 genotypes TT, TC, and CC were no different between patients and controls (26% vs. 22%). The TT genotype of polymorphism of the TGF-beta C-509T gene had no relation to the susceptibility of children to HSP and renal involvement in HSP. Conclusion: TGF-beta T allele may not be related to the susceptibility of children to HSP. The TT genotype of polymorphism of the TGF-beta C 509T gene does not appear to have an influence on renal involvement in childhood HSP.

Study Progress of Gastrointestinal Manifestations in Henoch-Scholein Purpura / 实用儿科临床杂志

Henoch-Scholein purpura(HSP)is a common systemic vasculitis of the small vessel in children,with a variety of clinical manifestations.The main diagnostic criteria include palpable skin purpura.Patients who have gastrointestinal tract as the main symptoms suffer clinically abdominal pain and gastrointestinal bleeding,they are easily misdiagnosed before skin purpura,the rate of misdiagnosis can be as high as 87.5%,and the main treatment is early application-oriented glucocorticoids.This review include etiopathogenisis,pathogenesis,pathology,clinical manifestations,auxiliary examination and treatment about gastrointestinal manifestations in HSP.

Henoch-Scholein Purpura Presenting with Acute Abdominal Pain Preceding Skin Rash: Review of 23 Cases

PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.

A Case of Hemorrhagic Bullous Henoch-Scholein Purpura: Cellulitis Presenting as a Complication / 대한피부과학회지

Henoch-Scholein Purpura(HSP) is a syndrome characterized by nonthrombocytopenic purpura accompanied by a arthralgia, gastrointestinal symptom, or renal involvement. This report describes a 13-year-old boy with hemorrhaic bullous HSP followed by cellulitis as a complication. This unusual cutaneous manifestation of HSP may be a source of diagnostic confusion, but it does not appear to have prognostic implication.