Zeitschrift für Rheumatologie

, Volume 76, Issue 4, pp 351–356 | Cite as

Application value of laboratory indexes in the differential diagnosis of Henoch–Schoenlein purpura

Originalien

Abstract

Objective

The aim of this study was to explore the value of laboratory indexes in the differential diagnosis of Henoch–Schoenlein purpura (HSP).

Methods

Patients with HSP hospitalized at the Children’s Hospital of Zhejiang University School of Medicine between January 2010 and December 2014 were enrolled in this prospective study. In addition, septic patients with rash and patients with urticaria, simple hematuria, and acute appendicitis hospitalized during the same period were selected at random as differential diagnosis subjects, and healthy children were selected as normal controls. The levels of IgA, D‑dimer, fibrinogen (FIB), and platelet (PLT) and the platelet distribution width (PDW) of these individuals were tested and analyzed, and the ROC curve was used to determine the applicability of these indexes to differentiate between patients with HSP and other diseases easily confused with HSP, as well as to determine the efficacy of combined diagnosis.

Results

There were remarkable differences in the levels of FIB, D‑dimer, IgA, PLT, and PDW among patients with HSP, sepsis patients with rash, patients with urticaria, simple hematuria, or acute appendicitis and healthy children (P < 0.01).

Conclusion

The levels of IgA, D‑dimer, and PLT can be applied separately for the differential diagnosis of HSP, and these indexes and FIB can be combined appropriately to improve the diagnostic efficacy.

Keywords

Henoch–Schoenlein purpura Allergy Diagnosis IgA Platelets 

Praktischer Wert von Laborindizes bei der Differenzialdiagnose der Purpura Schoenlein-Henoch

Zusammenfassung

Ziel

Ziel der Studie war es, den Wert von Laborindizes für die Differenzialdiagnose der Purpura Schoenlein-Henoch (PSH) zu untersuchen.

Methoden

In diese prospektive Studie aufgenommen wurden Patienten mit PSH, die in der Kinderklinik der Zhejiang University School of Medicine, Hangzhou, China, zwischen Januar 2010 und Dezember 2014 behandelt worden waren. Als Probanden für die Differenzialdiagnose wurden außerdem Patienten mit Sepsis und Exanthem sowie Patienten mit Urtikaria, einfacher Hämaturie und akuter Appendizitis zufällig ausgewählt, die im selben Zeitraum stationär behandelt wurden. Gesunde Kinder dienten als normale Kontrollen. Die Werte für Immunglobulin A (IgA), D‑Dimer, Fibrinogen (FIB) und Thrombozyten (PLT) sowie die Thrombozytenverteilungsbreite („platelet distribution width“, PDW) dieser Personen wurden bestimmt und ausgewertet. Anhand der Receiver-Operating-Characteristic(ROC)-Kurve wurde die Anwendbarkeit dieser Indizes für die Differenzierung zwischen Patienten mit PSH und anderen leicht mit PSH zu verwechselnden Erkrankungen sowie die Effektivität der kombinierten Diagnosestellung ermittelt.

Ergebnisse

Es bestanden deutliche Unterschiede bei den Werten für FIB, D‑Dimer, IgA, PLT und PDW zwischen Patienten mit PSH, Sepsispatienten mit Exanthem, Patienten mit Urikaria, einfacher Hämaturie oder akuter Appendizitis und gesunden Kindern (p < 0,01).

Schlussfolgerung

Die Werte für IgA, D‑Dimer und PLT können getrennt für die Differenzialdiagnose der PSH eingesetzt werden, außerdem können diese Indizes und FIB entsprechend kombiniert werden, um die diagnostische Effektivität zu verbessern.

Schlüsselwörter

Henoch-Schoenlein-Purpura Allergie Diagnose IgA Thrombozyten 

Notes

Acknowledgements

We are indebted to the parents and children who participated in this study for their time and generosity.

Funding

This project was supported by grants from the National Natural Science Foundation of China (Grant No. 81501760), Zhejiang Provincial Natural Science Foundation of China (Grant No. LQ16H050002), Zhejiang Provincial Healthy Science Foundation of China (Grant No. 2015KYB191). The funders did not take part in the study.

Compliance with ethical guidelines

Conflict of interest

W.-X. Shao, Q. Ye, and X.-J. Wang state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

References

  1. 1.
    Trnka P (2013) Henoch-Schonlein purpura in children. J Paediatr Child Health 49:995–1003CrossRefPubMedGoogle Scholar
  2. 2.
    Park SJ, Suh JS, Lee JH, Lee JW, Kim SH, Han KH, Shin JI (2013) Advances in our understanding of the pathogenesis of Henoch-Schonlein purpura and the implications for improving its diagnosis. Expert Rev Clin Immunol 9:1223–1238CrossRefPubMedGoogle Scholar
  3. 3.
    Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, Buoncompagni A, Lazar C, Bilge I, Uziel Y, Rigante D, Cantarini L, Hilario MO, Silva CA, Alegria M, Norambuena X, Belot A, Berkun Y, Estrella AI, Olivieri AN, Alpigiani MG, Rumba I, Sztajnbok F, Tambic-Bukovac L, Breda L, Al-Mayouf S, Mihaylova D, Chasnyk V, Sengler C, Klein-Gitelman M, Djeddi D, Nuno L, Pruunsild C, Brunner J, Kondi A, Pagava K, Pederzoli S, Martini A, Ruperto N, Ruperto (2010) EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 69:798–806CrossRefPubMedGoogle Scholar
  4. 4.
    Ramar K, Gajic O (2013) Early Recognition and Treatment of Severe Sepsis. Am J Respir Crit Care Med 188:7–8CrossRefPubMedGoogle Scholar
  5. 5.
    Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D (2014) The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 133:1270–1277CrossRefPubMedGoogle Scholar
  6. 6.
    Bohm M, Aufricht C (2011) Pediatric hematuria. Monatsschr Kinderheilkd 159:675–684CrossRefGoogle Scholar
  7. 7.
    Kosloske AM, Love CL, Rohrer JE, Goldthorn JF, Lacey SR (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34CrossRefPubMedGoogle Scholar
  8. 8.
    Yang YH, Yu HH, Chiang BL (2014) The diagnosis and classification of Henoch-Schonlein purpura: An updated review. Autoimmun Rev 13:355–358CrossRefPubMedGoogle Scholar
  9. 9.
    Pan YX, Ye Q, Shao WX, Shang SQ, Mao JH, Zhang T, Shen HQ, Zhao N (2014) Relationship between immune parameters and organ involvement in children with Henoch-Schonlein Purpura. PLoS ONE 9:e115261CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kawasaki Y (2011) The pathogenesis and treatment of pediatric Henoch-Schonlein purpura nephritis. Clin Exp Nephrol 15:648–657CrossRefPubMedGoogle Scholar
  11. 11.
    Saulsbury FT (2010) Henoch-Schonlein purpura. Curr Opin Rheumatol 22:598–602CrossRefPubMedGoogle Scholar
  12. 12.
    Saini SS (2014) Chronic spontaneous urticaria etiology and pathogenesis. Immunol Allergy Clin North Am 34:33CrossRefPubMedGoogle Scholar
  13. 13.
    Torkaman M, Afsharpaiman SH, Hoseini MJ, Moradi M, Mazraati A, Amirsalari S, Kavehmanesh Z (2009) Platelet count and neonatal sepsis: a high prevalence of enterobacter spp. Singapore Med J 50:482–485PubMedGoogle Scholar
  14. 14.
    Viswanathan R, Singh AK, Mukherjee S, Mukherjee R, Das P, Basu S (2011) An outbreak of neonatal sepsis presenting with exanthematous rash caused by klebsiella pneumoniae. Epidemiol Infect 139:226–228CrossRefPubMedGoogle Scholar
  15. 15.
    Lim SY, Jeon EJ, Kim HJ, Jeon K, Um SW, Koh WJ, Chung MP, Kim H, Kwon OJ, Suh GY (2012) The incidence, causes, and prognostic significance of new-onset thrombocytopenia in intensive care units: a prospective cohort study in a korean hospital. J Korean Med Sci 27:1418–1423CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Manzoni P, Mostert M, Galletto P, Gastaldo L, Gallo E, Agriesti G, Farina D (2009) Is thrombocytopenia suggestive of organism-specific response in neonatal sepsis? Pediatr Int 51:206–210CrossRefPubMedGoogle Scholar
  17. 17.
    Graff L, Russell J, Seashore J, Tate J, Elwell A, Prete M, Werdmann M, Maag R, Krivenko C, Radfor M (2000) False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 7:1244–1255CrossRefPubMedGoogle Scholar
  18. 18.
    Chen JY, Mao JH (2015) Henoch-Schonlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr 11:29–34CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Hangzhou First People’s HospitalHangzhouChina
  2. 2.The Children’s Hospital of Zhejiang University School of MedicineHangzhouChina

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