| Objective: Henoch-Schonlein purpura nephritis(HSPN)is a common secondary kidney disease,which mainly affects children.while adults are not uncommon.The manifestation of hematuria plus proteinuria was the most common in both adult HSPN and childhood HSPN.Age is thought to affect clinical features,pathological changes and TCM syndromes.We aimed to investigate the differences and to analyze the correlation between adult HSPN and childhood HSPN in those aspects mentioned above.Then we will perceive HSPN further,providing theory for HSPN in diagnosis,assessing severity,guiding treatment.Methods: A total of 349 patients(290 cases of childhood HSPN patients and 59 cases of adult HSPN patients)diagnosed with HSPN between January 2012 and December 2014 at the First Affiliated Hospital of Henan university of Traditional Chinese medicine,were retrospectively reviewed.All of these cases have complete clinical records,laboratory parameters and kidney pathology reports.We apply statistical methods in this retrospective analysis,exploring differences among clinical features,pathological changes and TCM syndromes in adult HSPN and childhood HSPN.Results: 1.The male to female ratio was 1.54:1 in childhood HSPN group and 1.03:1 in adult HSPN group;age :10.16 ±2.94 years old(mean ± SD),34.06±13.48 years old(mean ± SD)respectively.2.The clinical characteristics: A total of 325 cases of purpura,194 cases of arth-ralgia,175 cases of digestive,and 13 cases of gross hematuria in both pediatric HPSN patients and adult HSPN patients.171 cases of arthralgia and 163 cases of digestive were in childhood HSPN group,respectively,versus 23 cases,12 cases in adult HSPN group(all P<0.05).269 cases of purpura and 11 cases of gross hematuria in childhood HSPN group,respectively,versus 56 cases,2 cases in adult HSPN group(all P >0.05).3.laboratory parameters: Minimal proteinuria is the common type in childhood HSPN group,while moderate proteinuria in adult HSPN group.1.05± 0.86(mean ± SD)of proteinuria(g/d),3.38±0.75(mean ± SD)of cholesterol(mmol/L)in childhood HSPN group,respectively,versus 2.83±0.91(mean ± SD),4.78±0.83(mean ± SD)in adult HSPN group(all P <0.05).65.04± 7.01(mean ± SD)of Serum total protein(g/L),41.18±5.86(mean ± SD)of Serum albumin(g/L)in childhood HSPN group,respectively,versus 64.53±6.94(mean ± SD),40.53±5.17(mean ± SD),in adult HSPN group(all P >0.05).4.According to ISKDC pathological classification: The pathological changes of pediatric HPSN patients were mainly of grades ?and ?.54 cases of grade IIa,10 cases of grade IIb,151 cases of grade IIIa,64 cases of grade ?b were in childhood HSPN group.While a majority of adult(90%)patients were categorized as pathological grade HSPN.15 cases ? of grade IIIa and 38 cases of grade IIIb were in adult HSPN group(P<0.05).A majority of pediatric(72%)and adult(78%)patients having crescent lesions(P>0.05).While 12.08±12.50(%)(mean ± SD)in childhood HSPN group,versus 18.39±16.32(%)(mean ± SD)in adult HSPN group(P<0.05).Immune complex deposit:249 cases of Ig A deposit,7 cases of Ig A plus Ig G deposit and 34 cases of Ig A plus Ig M deposit were in childhood HSPN group,respectively,versus 48 cases,1 case,10 cases in adult HSPN group(P>0.05).C3 deposit:The majority of pediatric and adult patients having C3 deposit,which accounts for 62%(181 cases),54%(32cases)respectively(P>0.05).Tubular and interstitial lesion in renal:265 cases(91%)of grade +,21 cases(7%)of grade ++ and 4 cases(2%)of grade +++ were in childhood HSPN group,respectively,versus 8 cases(13%),30 cases(51%),21 cases(36%)in childhood HSPN group(P<0.05).5.Distribution characteristics of TCM syndromes:1 cases of dampness-heat intrinsic,231 cases of Xue re wang xing,46 cases of Qi-yin deficiency and 12 cases of Yin xu huo wang were in childhood HSPN group,respectively,versus 8 cases,9 cases,21 cases,21 cases in adult HSPN group(P<0.05).6.A significant positive correlation was noted between pathological type and TCM syndrome type in adult HSPN group(P<0.05),contrary to childhood HSPN group(P>0.057).7.24 hour urinary albumin excretion in both pediatric and adult patients: dampness-heat intrinsic(1.04±0.25 g,mean ±SD),Xue re wang xing(1.06±0.90 g,mean ±SD),Qi-yin deficiency(2.05±1.05 g mean ±SD),Yin xu huo wang(2.16±1.50 g,mean ± SD).The latter two groups have higher levels of proteinuria than the former two groups(all P<0.05).Conclusion: 1.Extra renal symptoms(arthritis and abdominal pain)were more common in the pediatric patient group than in the adult group.2.Adult patients have more severe renal histopathological changes than pediatric patients.3.Xue re wang xing is the most common manifestation in childhood HSPN group,while Qi-yin deficiency and Yin xu huo wang account for the largest proportion in adult HSPN group.4.A significant positive correlation was noted between pathological type and TCM syndrome type in adult HSPN group,contrary to childhood HSPN group.5.Qi-yin deficiency and Yin xu huo wang have higher levels of proteinuria than another two syndromes. |
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