İlyas YOLBAŞ, Servet YEL, Halil KOCAMAZ, İlhan TAN, Hasan BALIK, Ünal ULUCA, Aydın ECE

Çocuklarda Henoch-Schönlein purpurası: 214 hastanın değerlendirilmesi

Amaç: Henoch-Schönlein purpurası’nın (HSP) çeşitli sistemleri tutması ve klinik seyrinin farklılık göstermesi nedeniyle, bu çalışmada HSP’li çocukların klinik ve laboratuar özelliklerinin incelenmesi amaçlandı. Gereç ve yöntem: Dicle Üniversitesi Tıp Fakültesi Çocuk Kliniğinde 2000-2007 yılları arasında izlenen HSP’li 214 çocuk hastaya ait hasta kayıtları geriye dönüşlü olarak incelendi. Hastalık tanısı American Collage of Rheumatology’ nin HSP kriterlerine dayanılarak kondu. Hastaların yaş, cinsiyet, klinik bulgular, laboratuar değişkenler, uygulanan tedavileri ve sonuçları kaydedildi. Bulgular: Toplam 214 HSP’li çocuk hastanın (121 erkek, 93 kız) yaş ortalaması 9.0 ± 3.2 yıl (2-16 yaş arası) idi. Hastaların 136’sında (%63.6) bir üst solunum yolu enfeksiyonu geçirme öyküsü mevcuttu. Hastaların %62.1’inde karın ağrısı, %22.1’inde kusma, %25.4’ünde dışkıda gizli kan pozitifliği veya melena saptandı, üç hasta intusepsiyon nedeniyle opere edildi. Eklem tutulumu 117 (%54.7) hastada, kranio-fasyal ödem 73 (%34.3) hastada görüldü. Renal tutulum bulgusu olarak 63 hastada (%29.4) hematüri, 57 hastada (%26.6) proteinüri, 21 hastada (%9.8) lökositüri gözlenirken, 5 hastada nefrotik/nefritik sendrom görüldü. IgA yüksekliği 35 (%16) olguda C3 yüksekliği 41 hastada (%19.3), C3 düşüklüğü 23 hastada (%10.7) rastlandı. Tedavi olarak 114 hastaya (%53.3) benzatin penisilin+ penisilin V, 128 hastaya (%59.8) non-steroidal antiinflamatuar, 86 hastaya (%40.2) oral/parenteral steroid verildi. Nefrotik proteinürisi olan 5 hastaya renal biyopsi sonrası immunsupresif verildi. Sonuç: Henoch-Schönlein purpurasında özellikle gastrointestinal sistem ve renal tutulum nadiren önemli komplikasyonlara yol açmaktadır.

Henoch-Schönlein purpura in childhood: Review of 214 patients

Objectives: Due to involvement of various systems and clinical variety of in Henoch-Schönlein purpura (HSP), in this study, it was aimed to investigate clinical and laboratory features of children with HSP. Materials and methods: Hospital records of 214 children with HSP followed up between 2000 and 2007 at Dicle University Hospital Pediatrics Clinics were retrospectively evaluated. Diagnosis was made based on the HSP criteria of American College of Rheumatology. Age, gender, clinical findings, laboratory variables, applied treatments, and outcome were recorded. Results: Totally 214 HSP patients (121 male, 93 female) with the mean age of 9.0 ± 3.2 years (range, 2-16) were included. There was a history of upper respiratory tract infection in 136 children (63.6%). There was abdominal pain in 62.1% of patients, vomiting in 22.1%, and occult blood in stool or melena in 25.4%. Three patients underwent operation due to intusception. Joint involvement was seen in 117 (54.7%) and craniofacial edema in 73 (34.3%) of patients. Renal involvement as hematuria was seen in 63 (29.4%) children, proteinuria in 57 (26.6%), leukocyturia (9.8%), and nephritic/nephritic proteinuria in five patients. Increased IgA and C3 levels were found in 35 (16.0%) and 41 (19.3%), respectively; and decreased C3 in 23 (10.7%). Benzathine penicillin and penicillin V were used in 114 (53.5%) of children, non-steroidal antiinflammatory drugs in 128 (59.8%) and parenteral/oral corticosteroids in 86 (40.2%). Immonusuppressives were given to 5 patients with nephrotic proteinuria following renal biopsy. Conclusions: Gastrointestinal and renal involvement in children with HSP, rarely lead to major complications. J Clin Exp Invest 2012; 3(1): 91-95

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