Elevated Serum Levels of Visfatin in Patients with Henoch-Schonlein Purpura

BACKGROUND: Henoch-Schonlein purpura (HSP) is an immune complex-mediated disease predominantly characterized by the deposition of circulating immune complexes containing immunoglobulin A (IgA) on the walls of small vessels. Although the pathogenesis of HSP is not yet fully understood, some researchers proposed that B-cell activation might play a critical role in the development of this disease. OBJECTIVE: To investigate the serum levels of visfatin (pre-B-cell colony-enhancing factor), B-cell-activating factor (BAFF), and CXCL13, and to analyze their association with disease severity. METHODS: The serum levels of visfatin, BAFF, and CXCL13 were measured by using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) in 43 patients with HSP and 45 controls. The serum levels of IgA anticardiolipin antibodies (ACA) were detected by using a double-antigen sandwich ELISA. RESULTS: Levels of visfatin but not BAFF and CXCL13 were significantly elevated in the sera of patients with HSP in the acute stage, and restored to normal levels in the convalescent stage. Furthermore, serum levels of visfatin were significantly higher in patients with HSP having renal involvement than in those without renal involvement. Serum levels of visfatin were correlated with the severity of HSP and serum concentration of ACA-IgA. CONCLUSION: We show for the first time that the serum levels of visfatin are abnormally elevated in patients with HSP. Visfatin may be associated with the pathogenesis of HSP.

Treatment of Severe Henoch-Schoenlein Purpura Nephritis in Children

The overall prognosis of Henoch-Schoenlein purpura (HSP) is favorable, but severe nephritis has a high risk of progression to end stage renal failure. Recent studies emphasize the importance of early treatment in children with severe HSP nephritis, but the treatment of severe HSP nephritis still remains controversial due to the rarity of randomized controlled studies in this field. Nevertheless, several intensive therapies, such as intravenous high-dose methylprednisolone pulse, immunosuppressive/cytotoxic drugs, fibrinolytic therapy, anticoagulants, antiplatelet agent and plasma exchange, have been used in children with severe HSP nephritis. In this review, we focus on the treatment of severe HSP nephritis in children.

Effect of low molecular heparin calcium on Henoch-Schonlein purpura and Preventive Henoch-Schonlein purpura nephritis / 中国小儿急救医学

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.

Duodenal Perforation in a Child with Henoch- Schoenlein Purpura

Henoch-Schoenlein purpura is predominantly a childhood disease with good prognosis. It is characterized by nonthrombocytopenic purpura, arthritis, arthralgia, gastrointestinal symptoms and glomerulonephritis. Abdominal pain is the most common gastrointestinal symptom, however, some patient with Henoch-Schoenlein purpura have gastrointestinal major surgical complication such as intussusception, bowel infarction, necrosis, stricture and perforation. We report a case of duodenal perforation in a 6-year-old boy with Henoch-Schoenlein purpura, being treated with corticosteroids.

Association between CD_(14) Gene Promoter Region Polymorphisms and Henoch-Schonlein Purpura / 实用儿科临床杂志

Objective To study the allele and genotype distribution of CD14 gene promoter region-159C/T,-260C/T polymorphisms in Chinese patients with Henoch-Schonlein purpura(HSP),and to discuss the association between CD14 gene promoter region polymorphisms and HSP.Methods Under the case-control study,CD14-159C/T and CD14-260C/T site polymorphisms in 144 children with HSP and 180 healthy controls were analyzed with polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),and the relationship between CD14-159C/T and CD14-260C/T site polymorphisms and the risk of HSP were analyzed.SPSS 13.0 software was used to analyze the data.Results The distribution of CD14 gene-159C/T polymorphism was significantly different between gastro-intestinal(GI)involvement group,renal involvement group and healthy control group(P=0.041,0.010,respectively);but the CD14 gene-260C/T polymorphism was significantly different between simple lesion group,renal involvement group and healthy control group(P=0.003,0.037,respectively)and C and T allele were significantly different between simple lesion group,joint damage group,GI involvement group,renal involvement group,healthy control group(P=0.017,0.035,0.024,0.007)and the relative risk for different types of HSP in T allele carriers was higher than that in C allele carriers(simple lesion:OR=2.097,95%CI 1.131-3.823;joint:OR=1.603,95%CI 1.031-2.493;GI:OR=1.602,95%CI 1.062-2.415;renal:OR=1.843,95%CI 1.175-2.889;respectively).Conclusions CD14 gene promoter region polymorphism is associated with HSP and T alele of CD14-260C/T may be a risk factor for HSP.

Significance of Expression of Serum Soluble Vascular Cell Adhesion Molecular and Soluble Intercellular Molecule-1 in Children with Henoch-Schoenlein Purpura / 实用儿科临床杂志

Objective To detect the levels of plasma soluble vascular cell adhesion molecular(sVCAM-1) and soluble intercellular mo-lecule-1(sICAM-1) in children with Henoch-Schoenlein purpura(HSP) and its clinical significance.Methods The plasma levels of sVCAM-1 and sICAM-1 were measured by enzyme-linked immunosorbent assay(ELISA) in 53 children with HSP(37 cases in acute stage and 16 cases in recovery stage)and in 25 healthy subjects respectively,and the change that in acute stage and recovery stage was analyzed,at the same time,the 2 factors in children with renal injury and without injury were analyzed.Results The serum levels of sVCAM-1 and sICAM-1 in acute stage HSP children were significantly higher than those in recovery stage and normal controls(Pa

Significance of Detecting Serum and Urine Levels of Macrophage Migration Inhibitory Factor in Children with Henoch-Schoenlein Purpura Nephritis / 实用儿科临床杂志

0.05),but urine levels of MIF in children HSPN increased significantly than those in normal controls(P

Correlation between B beta-Fibrinogen Gene Polymorphism,Plasma Fibrinogen Level and Henoch-Schoenlein Purpura in Children / 实用儿科临床杂志

Objective To investigate the association of B?-fibrinogen gene-455G/A polymorphism and plasma fibrinogen levels with Henoch-Schoenlein purpura(HSP) in children.Methods Sixty-seven children(including 40 boys and 27 girls) with HSP were served as HSP group,age ranging from 5-14 years,with the average age of 9 years.Seventy healthy controls(including 37 boys and 33 girls) were served as healthy controls.Age ranging from 5-13 years,with the average age of 9 years.The B?-fibrinogen gene-455G/A polymorphism was detected in all subjects by polymerase chain reaction-restrictive fragment length polymorphism technique with restrictive enzyme HaeⅢ.Results There were a greater proportion of individuals with the AA,GA,GG genotype in the HSP group comparied with those of the healthy controls(?2=29.5 P0.05].Conclusions The B?-fibrinogen gene-455G/A mutation is correlated with HSP in children,A allele is susceptibility gene of HSP in children.The plasma fibrinogen level is related to HSP in children.

Small Intestinal Infarction Associated with Henoch-Schoenlein Purpura

Henoch-Schoenlein purpura, also known as anaphylactoid purpura, is characterized by palpable purpura, colicky abdominal pain, gastrointestinal hemorrhage, arthralgias, and renal involvement. Histopathologically, the condition represents a vasculitis, and in fact, it may be the most common vasculitis syndrome affecting children. The pathogenesis of Henoch-Schoenlein purpura remains poorly understood, but it is postulated that an unknown antigenic stimulus causes elevation of circulating IgA and that complement activation leads to necrotizing vasculitis. All of its clinical features are attributable to wide spread vasculits. Abdominal pain is the most common gastrointestinal symptom, but intestinal bleeding and intussusception may occur. Mesenteric vasculitis is a rare but potentially serious complication of systemic vasculitis. It is reported in association with rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polyarteritis nodosa, and giant cell arteritis in adult patients. Typical features are diffuse non-specific abdominal pain progressing on occasion to gastrointestinal hemorrhage, perforation, or more rarely infarction. Fortunately intestinal infarction is a rare complications, but if present carries a high chance of mortality, and swift management of the underlying vasculitis is crucial. We describe here an unusual case of a small intestinal infarction associated with Henoch-Schoenlein purpura caused by mesenteric vasculitis.

Comparative study of Henoch-Scholein purpura in adults and children / 中华风湿病学杂志

Objective To assess the possible differences of the clinical features and renal pathology between children and adults with Henoch Schoelein purpura (HSP),and the contribution of clinical and renal biopsy parameters to predict the disease outcome.Methods A retrospective study was performed in 156 patients with HSP.Patients younger than 16 years at disease onset were considered children,and those aged 16 years or over were considered adults.Results The male was more prevalent in both adults and children HSP groups (M∶F=1 5∶1).The previous drug treatment,and special food intake were more frequent among the adults ( P =0 03 and 0 009,respectively).Renal involvement,increased ESR and serum IgA levels were more frequent in adults,but vomiting and joint pain were more in children.The frequencies of previous upper respiratory tract infection (URTI),fever,abdominal pain,melena and nephrotic syndrome were similar in both groups.Multivariate analysis showed that age at the disease onset,URTI and abdominal pain were predictive for renal involvement (RR=7 8,4 1 and 4 6,respectively).There were no differences of the renal pathologic types between two groups.However,lesions other than glomeruli including tubular and interstitial involvement were more frequent in adults.The outcome was better in children after a mean follow up of 6 2 years.Renal disease was the main clinical manifestation in non complete remission (NCR) patients.The proteinuria and the other area lesions out of glomeruli predict the decreased remission rate (RR=5 3 and 6 7,respectively).Conclusion These results indicate that HSP is more serious and nephritis is more frequent in adults.Proteinuria and lesions other than glomeruli are the higher risk factors of NCR.

A Case of Henoch-Schoenlein Purpura with Necrotizing Vasculitis in the G-I Tract / 대한피부과학회지

Henoch-Schoenlein purpura is a syndrome of acute systemic allergic vasculitis involving the small vessels of skin and multiple organs, characterized by a symmetrical, non-thrombocytopenic, painless purpura, nephritis and gastrointestinal manifestations. Although GI involvement is about 70%, endoscopic and histopathological finding of the GI tract in Henoch-Schoenlein purpura is rarely reported and necrotizing vasculitis in GI tract biopsy has not been reported yet. We report a case of a 16-year-old male patient, who complained of palpable purpura, vomiting and epigastric pain with necrotizing vasculitis of the duodenum on histopathological examination.

A case of diffuse alveolar hemorrhage associatedwith Henoch-Schoenlein purpura / 결핵

Diffuse alveolar hemorrhage is a very rare manifestation in Henoch-Schoenlein purpura. Recently we experience a case of diffuse alveolar hemorrhage associated with Henoch-Schoenlein purpura which was diagnosed by typical clinical manifestation and renal biopsy. A 25 year old male was admitted due to hemoptysis and dyspnea. Chest X-ray, HRCT and BAL revealed diffuse alveolar hemorrhage. He also had a history of skin rash, polyarthralgia, and hematochezia with abdominal pain. Renal biopsy which was taken for the evaluation of microscopic hematuria showed IgA nephropathy. Under the diagnosis of Henoch-Schoenlein purpura, we treated him with solumedrol pulse therapy, plasma-pheresis and prednisolone with cytoxan. After then he showed marked improvement in clinical manifestation and was discharged with prednisolone and cytoxan.