过敏性紫癜患儿静脉血ICAM—1的表达意义

目的 探讨全身血管炎症性疾患－过敏性紫癜细胞间粘附分子－１（ＩＣＡＭ－１）的表达意义。方法 采用半定量反转录－聚合酶链反应测定了１３例患儿及５名健康儿静脉血白细胞中ＩＣＡＭ－１表达。结果 １２例患儿呈阳性表达（９２．３１％），４Ｑ名健康儿呈阴性表达；患儿中６例有肾脏损害（４６．１５％），其中５例ＩＣＡＭ－１表达阳性。经秩和检验，患儿组与对照组间有明显差异（Ｐ〈０．００５）。结论 ＩＣＡＭ－１是全身     

过敏性紫癜的诊断与治疗

过敏性紫癜(anaphylactoid purpura)又称亨一舒综合征(HSP)，是儿童时期最常见的血管炎之一。以非血小板减少性紫癜、关节炎、腹痛、胃肠道出血及肾炎为主要临床表现。     

过敏性紫癜与病毒感染的相关性探讨

过敏性紫癜 (Henoch Schonleinpurpura ,HSP)是儿科常见的自身免疫性小血管炎 ,可引起心脑肾等重要器官并发症 ,尤其可引起肾功能衰竭。该病病因很复杂 ,许多HSP患儿发病早期有呼吸道或其他部位的感染 ,因此感染可能是HSP发病的一个重要原因。近几年国外关于病毒感染引起HSP的报道很多 ,本文主要探讨临床常见的几种病毒感染、支原体感染 ,尤其是巨细胞病毒感染与HSP发生的相关性。我们对 2 0 0 1年 8月至 2 0 0 2年 2月在我院住院的 30例HSP患儿应用荧光定量聚合酶链反应法进行了EB病毒 (Epstein Barrvirus,EBV)、单纯疱疹病毒 …     

小儿过敏性紫癜与食物过敏原的关系

小儿过敏性紫癜（ＡＰ）是小儿常见的一种坏死性小血管炎。有反复发作的倾向。有文献报道食物过敏原与ＡＰ有关。为此，我们对３０例急性ＡＰ患儿及３０例缓解期患儿进行食物过敏原检查。报告如下，并讨论其关系。１资料与方法１．１一般资料随机抽取３０例急性期ＡＰ患儿...     

过敏性紫癜患儿心电图异常分析

过敏性紫癜是一种以小血管炎为主要病变的变态反应性疾病。1997～2002年，我院收治过敏性紫癜患儿50例，均合并心电图异常。现分析如下。     

成人和儿童过敏性紫癜的对比研究

目的　研究分析成人和儿童过敏性紫癜 (HSP)在临床及肾脏病理方面的不同特点以及影响HSP预后的危险因素。方法　对 15 6例HSP进行回顾性随访分析。患者发病年龄 <16岁为儿童组 ,≥ 16岁者为成人组 ,比较两组HSP在临床、肾脏病理和预后方面的差异 ,分析各种参数对HSP预后的影响程度。结果　成人和儿童HSP的发生均以男性较多见。成人因服用药物和食物诱发HSP者明显多于儿童组。临床上成人HSP肾脏受累 ,血沉和血清IgA升高的发生率明显比儿童组高。儿童HSP患者关节受累和呕吐者更多见。上呼吸道感染、发热、腹痛、黑便和肾病综合征的发生率两组差异无显著性。肾脏受累风险的增加与患者的发病年龄 [相对风险系数 (RR) =7 8],上呼吸道感染史 (RR =4 1)和腹痛病史 (RR =4 6 )密切相关。HSP肾脏的病理类型两组间差异无显著性 ,但成人肾小球外病变 (肾小管和间质病变 )的发生率明显高于儿童组。随访发现儿童HSP的完全缓解率 (76 7% )明显高于成人组 (45 2 % ) ,不全缓解者均表现为肾脏病变。临床蛋白尿和病理有肾小球外病变与HSP的预后密切相关 (RR分别为 5 3和 6 7)。结论　成人和儿童HSP在临床及肾脏病理上有明显不同的特点。成人HSP临床表现相对较重 ,肾脏受累多见 ,完全缓解率低。蛋白尿和肾小球外病变     

过敏性紫癜误诊原因分析

过敏性紫癜是儿童时期以毛细血管炎为主要病变的变态反应性疾病 ,临床除表现皮肤紫癜外 ,常有过敏性皮炎、关节肿痛、腹痛、便血和血尿等。 1993～ 2 0 0 1年 ,我们收治过敏性紫癜患儿 47例 ,其中 6例误诊 ,现报告如下。临床资料 :本组男 2例 ,女 4例 ;年龄 1～ 10岁。发病季节不显著 ,其中无明显诱因 2例。病前有感染、肠虫症、药物外敷、疫苗注射史各 1例。初诊时首发症状为腹痛 5例 ,呕吐 2例 ,便血、发热、双髁淡红色丘疹各 1例 ,其中 1例血、尿淀粉酶增高 ,腹部 B超示急性胰腺炎。误诊为细菌性痢疾、败血症、肠蛔虫症、急性胰腺炎、荨…     

西米替丁治疗儿童过敏性紫癜70例疗效观察

过敏性紫癜是由于某些过敏因素引起的变态反应性疾病 ,在儿科较为常见。 1995～ 2 0 0 0年 ,我们收治过敏性紫癜患儿 140例 ,对其中 70例采用西米替丁治疗 ,效果满意 ,现报告如下。资料与方法 :本文观察对象为 140例过敏性紫癜患儿 ,其中男 82例 ,女 5 8例 ,年龄 3～ 14岁 ,平均 8.4岁。紫癜为单纯皮肤型 37例 ,腹型 2 8例 ,关节型 2 4例 ,肾型 16例 ,混合型 35例。外周血常规检查 ,血小板计数及出、凝血时间均正常 ;白细胞增高 5 2例。轻度贫血 2 1例 ,均排除其它原因引起的出血性疾病。心电图检查异常 31例 ,主要为窦性心动过速、窦性心律…     

儿童过敏性紫癜内镜与临床分析

目的探讨儿童过敏性紫癜内镜下病变,以及与临床的关系,为早期诊断提供依据。方法2000年8月至2004年4月收治的51例过敏性紫癜患儿进行内镜检查,并分析其病变特征和临床的关系。结果51例患儿中,15例内镜下未见明显异常;36例有不同程度的胃、十二指肠和结肠的黏膜受损;其中,单纯胃镜下病变4例,单纯结肠镜下病变7例,胃、十二指肠和结肠同时出现病变25例。病变以黏膜渗出、糜烂、出血为主要特征。结论多数过敏性紫癜患儿存在胃肠道黏膜受累情况,有些病变早于皮肤紫癜出现之前,提示内镜检查对过敏性紫癜的早期诊断具有重要意义。     

中西医结合治疗小儿过敏性紫癜105例

1994年 5月～ 2 0 0 1年 2月 ,我们采用中西医结合疗法治疗 5 5例小儿过敏性紫癜 ,取得满意疗效。现报告如下。一般资料 :同期收治 10 5例过敏性紫癜患儿 ,随机分为两组 :1治疗组 :5 5例。其中男 35例 ,女 2 0例 ;年龄 3～ 13岁 ,平均 6 .9岁 ;腹型 2 5例、关节型 14例 ,肾型 16例。中医分型 :风热型 34例、湿毒型 2 1例。 2对照组 :5 0例。其中男 30例 ,女2 0例 ;年龄 3～ 12岁 ;关节型 18例 ,肾型 12例 ,腹型 2 0例。两组患儿按《儿科学》第 4版过敏性紫癜诊断标准确诊。治疗方法 :对照组采用以下治疗 :1用激素地塞米松 ,缓解后改为强的松…     

Pleural haemorrhage in Henoch Schonlein purpura

Summary We describe a seven-year old boy with Henoch-Schonlein purpura who presented with extensive skin rash, arthritis, and persistent abdominal pain. He was found to have small intestinal submucosal and subserosal haemorrhage on exploratory laparatomy. He developed pleural haemorrhages in the course of the disease, which to our knowledge has not been reported before in this disease.     

蒙汉族儿童过敏性紫癜临床特点与HLA-DRB1基因关联性对比分析

目的　探索内蒙古地区蒙、汉族儿童过敏性紫癜 (AP)临床特点的不同与HLA DRB1等位基因的关联性。方法　选择祖籍三代居住内蒙古地区 ,无血缘关系、与异族通婚史及其他风湿性疾病史和家族史的蒙、汉族儿童AP 5 7例和 74例。比较临床特点 ,引入PCR SSP技术 ,分析HLA DRB1等位基因的型别 ,结合检索查新分析讨论。结果　①汉族病例组肾、心、多器官损害、肾病综合征、肾病综合征伴肾炎综合征损害率分别为 5 4 %、30 %、73%、12 %和 15 % ;比蒙古族相应损害率为 35 %、5 %、4 2 %、0和 0增高 (χ2 值分别是 4 6 6 6、12 4 82、12 736、—和— ,P分别为 0 0 31、0、0、0 0 0 5和 0 0 0 2 )。蒙古族平均住院 (18± 7)d ,比汉族 (2 7± 18)d短 ,(t′ =2 4 5 0 ,P =0 0 2 1)。②蒙古族病例组DRB1 110x基因频率为 13 2 % ,高于对照组 6 1% (χ2 =4 378,P =0 0 36 ) ,OR =2 386 ,95 %可信区间为 1 0 4 5～ 5 4 4 7。汉族病例组DRB1 0 10x基因频率为 14 6 % ,高于对照组4 8% (χ2 =10 0 7,P =0 0 0 2 ) ,OR =3 4 36 ,95 %可信区间为 1 5 4 3～ 7 6 5 2 ;而DRB1 0 80x基因频率为 2 7% ,低于对照组 8 7% (χ2 =5 2 4 ,P =0 0 2 2 )。并得出OR =0 337,95 %可信区间为 0 12 0～0 94 7。③汉族病     

HLA class 1 associations in Henoch Schonlein purpura: increased and decreased frequencies

Henoch Schonlein purpura (HSP) is the most common vasculitis of childhood. Susceptibility to HSP and associated clinical heterogeneity in HSP may be conferred by a number of genetic loci, including the major histocompatibility complex. We aimed to investigate the implications of the human leukocyte antigen (HLA) class 1 alleles in susceptibility to HSP and determine the possible associations with renal, gastrointestinal (GI), and joint manifestations of the disease. 110 children with HSP (66 boys, 44 girls) and 250 unrelated healthy controls were enrolled in the study. The mean age was 8.65 ± 3.59 years. HSP was diagnosed on the basis of clinical and laboratory data according to the American College of Rheumatology classification. The diagnosis was supported with skin and/or kidney in most of the patients. Clinical and laboratory findings revealed: skin involvement in 110 (100%), joint manifestations in 82 (74.5%), GI symptoms in 58 (52.7%), and hematuria and/or proteinuria in 36 (32.7%) patients. HLA class 1 alleles were identified by DNA amplification, hybridized with specific primer sequences. Comparison of frequencies between patients and controls were made by using the Fisher’s exact test. Odds ratio (OR) was used as the measure of association. HLA A2, A11, and B35 antigens showed an increased risk for predisposition to HSP (OR = 1.714, 95%CI = 1.088–2.700, p = 0.020; OR = 2.185, 95%CI = 1.289–3.703, p = 0.003; and OR = 2.292, 95%CI = 1.451–3.619, p = 0.000, respectively), while HLA A1, B49, and B50 antigens revealed decreased risk for predisposition to HSP (OR = 4.739, 95%CI = 1.828–12.345, p = 0.001; OR = 3.268, 95%CI = 0.955–11.236, p = 0.047; and OR = 7.462, 95%CI = 0.975–55.555, p = 0.024, respectively). Considering the renal involvement and severity of proteinuria, there was no association with HLA class 1 alleles. Our results suggest that the increased frequency of HLA A2, A11, and B35 alleles in unselected pediatric HSP patient population and miscarrying of HLA A1, B49, and B50 could be considered as a risk factor for susceptibility to HSP.     

The role of chemokines in Henoch Schonlein Purpura

Background The pathogenesis of Henoch Schonlein Purpura is incompletely understood and the role of chemokines is unknown. Objective To investigate the levels of CC chemokines, eotaxin, TARC, and CXC chemokine IP-10 in Henoch Schonlein Purpura. Methods Three groups of children were enrolled in the study: Henoch Schonlein Purpura in active stage (n = 26), Henoch Schonlein Purpura in remission phase (n = 26) and healthy children (n = 18). Levels of eotaxin, TARC, and IP-10 were determined in plasma using ELISA. Results No significant difference was observed in the plasma level of eotaxin and TARC levels between the HSP and healthy children (>0.05). We could not find any significant difference between acute phase of the disease and convalescent phase in eotaxin and TARC levels (P > 0.05). We have suggested significant decreases in plasma IP-10 in the acute phase of the disease compared with the convalescent phase (P < 0.05). There was a significant difference in IP-10 levels between active stage and healthy controls, too (<0.05). We could not find any significant correlation between chemokine levels and system involvement (>0.05). Conclusion Our study shows that plasma level of eotaxin and TARC levels do not differ between the HSP and healthy children. But, decreasing the release of the Th1 chemokine IP-10 in HSP active stage may show that in HSP, there is no shift to Th1 lymphocytes in children with HSP. Further investigations are warranted to more fully explore and understand the production of and potential role of these chemokines in HSP.     

过敏性紫癜急性期患儿淋巴细胞凋亡特征的研究

为探讨过敏性紫癜(HSP)患儿急性期外周血淋巴细胞凋亡特征及其与T淋巴细胞免疫应答活性的相关性，选择HSP患儿及健康儿童各33例(HSP组及对照组)，分别应用形态法、间接免疫荧光法检测外周血淋巴细胞凋亡率、T淋巴细胞亚群及CD^ 23细胞百分率。结果HSP组急性期外周血淋巴细胞培养前及培养、48小时凋亡率均显著高于对照组(P均＜O．01)，外周血CD^ 4细胞百分率及CD^ 4／CD^ 4均明显低于对照组(P＜O.01，P＜0．05)；培养48小时CD^ 25细胞百分率显著低于对照组(P＜O．01)；培养48小时淋巴细胞凋亡率与CD^ 25细胞百分率呈负相关(P＜0．05)。认为HSP患儿外周血淋巴细胞凋亡过度，此与其T淋巴细胞免疫应答活性低下关系密切。     

Cryoglobulinemic purpura in visceral leishmaniasis

Visceral leishmaniasis may present with cytopenias along with the formation of many autoantibodies and, rarely, with the presence of mixed cryoglobulinemia, type II, resembling an autoimmune disease. The syndrome of mixed cryoglobulinemia is characterized by the triad of purpura, arthralgias, and asthenia, in conjunction with cryoglobulins in the serum. In this article mixed cryoglobulinemia, type II, was diagnosed in a negative for hepatitis B or C patient suffering from visceral leishmaniasis. Antimicrobial therapy against leishmania eliminated the cryoglobulin titer, as well as the clinical manifestations of cryoglobulinemia. The role of the immune system and the type of immune response for the formation of cryoglobulins are discussed.     

充血性心力衰竭患者血清VCAM-1、ICAM-1含量的变化

目的:观察充血性心力衰竭(CHF)患者血清中血管细胞粘附分子-1(VCAM-1)、细胞间粘附分子-1(ICAM-1)浓度变化。方法:应用酶联免疫吸附分析法测定56例CHF患者和55名健康对照者血清中VCAM-1、ICAM-1浓度。结果:CHF患者组血清ICAM-1浓度和VCAM-1浓度均明显高于正常对照组(P<0.05),而且与心功能状态有关。冠心病所致CHF患者与扩张型心肌病所致CHF患者血清ICAM-1与VCAM-1无显著性差别(P>0.05)。结论:CHF患者血清VCAM-1和ICAM-1浓度升高,而且VCAM-1浓度与心力衰竭的程度有关。提示炎症有可能在充血性心力衰竭发病机制中起作用。     

Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature

OBJECTIVE: To examine epidemiological, clinical, and outcome in Italian children affected with Henoch Sch?nlein purpura (HSP). METHODS: Retrospective study of children discharged with a diagnosis of HSP from the Meyer Children's Hospital, between 1998 and 2002. Epidemiological, clinical, laboratory data, treatment, and outcome were collected by reviewing medical charts. One year after data collection, the children's parents were interviewed by telephone about the outcome. RESULTS: 150 children entered the study: M:F=1.8:1; mean age 6.1+/-2.7 years. At onset, purpura was present in all cases, arthritis/arthralgias in 74%, abdominal involvement in 51%, scrotal edema in 13%, renal involvement in 54%, severe nephropathy in 7%, acute renal insufficiency in 2%, and intussusception in 0.6%. Purpura was the presenting symptom in 74%, arthritis in 15%, and abdominal pain in 12%. The most frequent laboratory abnormalities were high-erythrocyte sedimentation rate (ESR) (57%), hyper-IgA (37%), and proteinuria (42%). All patients recovered within 2 months. Recurrences, verified in 35%, were correlated with high ESR values and corticosteroid (CS) treatment, independently from other variables. After a mean 2.5-years follow-up, 2 patients had hematuria with normal renal function. CONCLUSION: Epidemiological and clinical findings in our cohort are similar to those in the literature, even though the mean disease duration was shorter than previously reported. Relapses occurred significantly more frequently in children treated with CS. This finding supports the recommendation to limit the use of steroids to a carefully selected group of HSP children. The prognosis was excellent; although severe nephropathy was found in a small percentage of the children, at follow-up all had normal renal function. Thus, our study confirms the benignity of HSP in Italian children, especially regarding renal outcome.     

Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period

We aimed to evaluate the patients who were diagnosed as Henoch Schonlein purpura (HSP) for disease characteristics and prognosis of those with joint, gastrointestinal (GI), and renal involvement. Two hundred and fifty-four children who were followed up with the diagnosis of HSP in the Pediatric Nephrology Clinics of Meram Medical Faculty of Selcuk University and Medical Faculty of Gazi University between January 2003 and June 2006 were retrospectively evaluated. The clinical follow-up and treatment regimens of patients in whom renal biopsy was performed were evaluated in detail. The study group consisted of 254 children, 147 boys (57.8%) and 107 girls (42.2%), and the ratio of boys to girls was 1.37. The percentages of skin, joint, GI, and renal manifestations were 100%, 66%, 56%, and 30%, respectively. Eight patients had intussusception. Five of them recovered with steroid treatment only while three patients were operated on. Sixty-four patients (44%) with GI involvement had severe disease and were successfully treated with steroids. Renal biopsy was performed in 26 patients. Among those 26 patients, two of them recovered spontaneously within 3 and 4 weeks. Ten patients improved with only steroid treatment while 12 patients recovered with steroid and cyclophosphamide treatment. Two patients were resistant to steroid and cyclophosphamide treatment and were treated with cyclosporine A. We believe that steroid therapy given to the HSP patients with GI manifestations might be helpful to prevent probable complications such as GI bleeding and intussusception. In addition, combined therapy with steroid and cyclophosphamide can usually be an appropriate treatment for patients with nephrotic proteinuria.