B. Ç. ACAR, Y. Deniz ARIKAN, F. İ. ARIKAN, Y. DALLAR

Çocukluk çağında henoch schönlein purpurası tanısı ile izlenen 168 olgunun sistem tutulumlarının değerlendirilmesi

Amaç: Henoch Schönlein Purpurası (HSP) çocukluk çağında sık karşılaşılan sistemik vaskülittir. Çalışmamızda HSP tanısıyla takip edilen hastaların demografik özelliklerinin değerlendirilmesi amaçlandı. Yöntem ve Gereç: 1 Mart 2004/31 Aralık 2007 tarihleri arasında S.B. Ankara Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniğine başvuran HSP tanısı ile izlenen en az 6 ay düzenli izlemlerine devam edilmiş 168 hasta retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen hastaların 102'si erkek (%61), 66‘sı kızdı (%39). Yaş ortalaması 8.8± 3.1 yıl olarak bulundu. İzlem süresi 6-66 aydı (29±17,6 ay). Hastaların 168'inde (%100) purpurik döküntü, 59' unda (%35) artrit/artralji, 34‘ünde (%20) gastrointestinal sistem (GİS), 33‘ünde (%20) renal, 2‘sinde (%1) testiküler tutulum saptandı. GİS tutulumu olan çocukların %80'i erkekti. GİS dışında diğer sistem tutulumları ile cinsiyet arasında anlamlı ilişki saptanmadı (p>0,05). GİS tutulumu olan hastaların ultrasonografi incelemesinde 5 hastada (%35) barsak duvarında ödem, 3 hastada (%22) barsak ansları arasında serbest sıvı, 1 hastada ise sağ alt kadranda kanamaya bağlı kalınlaşma saptandı. Böbrek tutulumu olan hastaların 12'sinde (% 35) 40 mg/m2/saate ulaşmayan düzeyde proteinüri, 2'sinde (%6) nefrotik düzeyde proteinüri saptandı. 20 hastada izole hematüri bulundu. En sık ayak bileği (%73) eklemi tutulumu tespit edildi. Yüzkırksekiz hastada hastalık tekrarlamazken, 12 hastada bir, 5 hastada iki, 3 hastada ise üç kez hastalık tekrarladı. Sonuç: Çalışmamızda HSP tanısıyla izlenen hastalarda en sık rastlanan semptom purpurik döküntü iken ikinci sıklıkla artrit/artralji bulunmuştur. Hastaların % 20'sinde GİS ve renal tutulum saptanmıştır. Özellikle renal tutulum olan hastaların uzun dönemde idrar tetkiki ile proteinüri açısından düzenli takiplerinin yapılması gerekmektedir.

System involvement evaluation of 168 case which is observed with henoch schönlein vasculitis in childhood

Aim: Henoch Schönlein purpura (HSP) is the most common systemic vasculitis in children. Characterized by small vessel vasculitis. The aim of this study was to determine demoraphic characteristics of HSP patients. Material and Methods: The medical records of 168 children with HSP revieved retrospectiveley. They were administered to Turkish Ministry of Health Ankara Training and Research Hospital Pediatric Clinic between March 2004- December 2007 and followed up at least 6 months. Results: Among the 168 patients enrolled to the study 102 were male (%61) and 66 were female (%39). Mean age was 8.8±3.1 years. Follow up period was 6-66 months (29±17,6). All patients had purpuric skin lesions (%100) , 59 had arthritis/ artralgia, 34 had GIS, 33 had renal and 2 had testicular involvement. Patients were % 80 male who had GIS involvement. Except GIS involvement there is no relationship between sex and other system involvement (p>0,05. Patients who had GIS involvement assessed with USG and found that 5 had intestinal edema (%35), 3 had asit (%22) and 1 had right upper quadrant thickness due to hemorrhage. Among the patients who had renal involvement 12 had (%35) proteinuria less than 40 mg/m2/hour, 2 had nephrotic proteinuria and 20 patients had isolated hematuria. The most common affected joint was found to be as ankle (%73). The illness didn't relapse in 148 of all patients, 12 had one, 5 had two, 3 patients had three reccurrences. Conclusion: In our study purpuric skin lesions are the most common symptom ,secondly arthrit and arthralgia found at patients who were following for HSP. Renal and GIS involvement found %20 of patients. Long term follow up had to be made for the patients especially who had renal involvement with routine ürinalysis for proteinuria

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