RÉSUMÉ
Objective To investigate the clinical and pathological characteristics of Henoch-Sch?nlein purpura nephritis with diffuse capillary endothelial cell proliferation as pathological manifestation. Methods The clinical manifestations and pathology of capillary endothelial proliferative purpura nephritis (DEP-HSPN) diagnosed by renal biopsy were retrospectively analyzed in 50 children in recent 5 years. Results The pathological lesions in 50 cases included simple DEP-HSPN in 11 cases (7 males and 4 females) and capillary endothelial cell proliferation combined with crescents formation (non-simple DEP-HSPN) in 39 cases (27 males and 12 females). There was no significant difference in the course of disease and age between the two groups (P>0.05). The clinical type of 11 cases of simple DEP-HSPN was type Ⅲ. In 39 cases of non-simple DEP-HSPN, 16 cases were type Ⅲ and 23 cases were type Ⅴ. All of the children had hematuria and proteinuria. The incidence of gross hematuria, urine red blood cell count, 24 h urine protein, and serum creatinine levels in children with non-simple DEP-HSPN were significantly higher than those in simple DEP-HSPN group, but the plasma albumin level was significantly lower than that in simple DEP-HSPN group. It was easy to have crescent formation in DEP-HSPN, and the rate of crescent formation was 11.1％ (5.0％-27.6％). The incidence of segmental lesions and renal tubular interstitial damage was low. All children had non simple IgA deposits in the mesangial area. In the 50 children treated for 1 year, 22 had complete remission, 28 had asymptomatic hematuria, and none had active nephropathy and renal insufficiency. In 32 cases of non-simple DEP-HSPN, the 24 h urinary protein, plasma albumin level, and the incidences of gross hematuria and microscopic hematuria were statistically different before treatment and 1, 3, 6, 12 months after treatment (P<0.01). The 24 h urine protein and gross hematuria gradually decreased with the prolongation of treatment, while the level of plasma albumin was gradually increased. Conclusions DEP-HSPN is characterized by gross hematuria and proteinuria. The onset is acute and it is easy to have crescent formation. When combined with crescent formation, the clinical symptoms are more severe. The combination of strong immunosuppressive agents and long-term sequential follow-up treatment is effective in acute stage. The prognosis is good.
RÉSUMÉ
Objective To explore the clinical features, endoscopic changes, and histopathological features of abdominal type Henoch-Scho..nlein purpura (HSP) in children. Methods The clinical data of 151 children with HSP who had abdominal pain as the primary symptom from June 2011 to June 2016 were analyzed retrospectively. Results A total of 151 children with HSP, (87 males and 64 females) aged 4.8 - 11.5 years, were enrolled. All of them had abdominal pain. There were 100 cases of cutaneous purpura (66.22%), 72 cases of vomit (47.68%), 59 cases of haematemesis (39.07%), 44 cases of hematochezia (29.13%) and 8 cases of joint swelling and pain (5.29%). Peripheral blood leucocytes increased in 114 cases (75.49%), C-reactive protein increased in 48 cases (31.78%), and albumin decreased in 21 cases (13.90%). It indicated the localized thickening of the intestinal wall in 49 cases (32.45%) by B-ultrasound. Gastroscopy was performed in 96 cases and main findings were patchy hemorrhage and erythema (89 cases, 92.70%), erosion or ulcer accompanied by bleeding (68 cases, 70.83%), ecchymosis (37 cases, 38.54%) and hematoma like process (13 cases, 8.60%). The descendent duodenum was the most common and had the most serious lesions, followed by gastric antrum and duodenal bulb. Histopathology showed capillary inflammation in 37 cases, 10 of which were accompanied by Helicobacter pylori infection.Enteroscopy was performed in 55 cases and main findings were punctate hemorrhage and erythema (49 cases, 89.09%), and erosion or multiple ulcer with hemorrhage (27 cases, 49.09%). The terminal ileum was the most common and had the most serious lesions, followed by rectum. Conclusions The clinical features of abdominal type HSP in children are varied, and it often involves descendent duodenum and terminal ileum. Endoscopic examination is valuable for the diagnosis of abdominal type HSP in children.
RÉSUMÉ
Objective To explore the clinical features, endoscopic changes, and histopathological features of abdominal type Henoch-Scho..nlein purpura (HSP) in children. Methods The clinical data of 151 children with HSP who had abdominal pain as the primary symptom from June 2011 to June 2016 were analyzed retrospectively. Results A total of 151 children with HSP, (87 males and 64 females) aged 4.8 - 11.5 years, were enrolled. All of them had abdominal pain. There were 100 cases of cutaneous purpura (66.22%), 72 cases of vomit (47.68%), 59 cases of haematemesis (39.07%), 44 cases of hematochezia (29.13%) and 8 cases of joint swelling and pain (5.29%). Peripheral blood leucocytes increased in 114 cases (75.49%), C-reactive protein increased in 48 cases (31.78%), and albumin decreased in 21 cases (13.90%). It indicated the localized thickening of the intestinal wall in 49 cases (32.45%) by B-ultrasound. Gastroscopy was performed in 96 cases and main findings were patchy hemorrhage and erythema (89 cases, 92.70%), erosion or ulcer accompanied by bleeding (68 cases, 70.83%), ecchymosis (37 cases, 38.54%) and hematoma like process (13 cases, 8.60%). The descendent duodenum was the most common and had the most serious lesions, followed by gastric antrum and duodenal bulb. Histopathology showed capillary inflammation in 37 cases, 10 of which were accompanied by Helicobacter pylori infection.Enteroscopy was performed in 55 cases and main findings were punctate hemorrhage and erythema (49 cases, 89.09%), and erosion or multiple ulcer with hemorrhage (27 cases, 49.09%). The terminal ileum was the most common and had the most serious lesions, followed by rectum. Conclusions The clinical features of abdominal type HSP in children are varied, and it often involves descendent duodenum and terminal ileum. Endoscopic examination is valuable for the diagnosis of abdominal type HSP in children.
RÉSUMÉ
Henoch-Scho..nlein purpura (HSP) is a common systemic inflammatory disease of small blood vessels in children. With the gastrointestinal involvement, it is called abdominal type of HSP. The main diagnostic method of abdominal type of HSP is gastrointestinal endoscopy, which can scan the digestive tract lesions directly and take the biopsy. It is of irreplaceable value for the early diagnosis of HSP with gastrointestinal involvement. This article reviews the literatures of endoscopy application in pediatric abdominal type of HSP at home and abroad, and summarizes the endoscopic features and diagnosis of abdominal HSP in children.