Abstract:

Objective To study the value of immunofluorescence test and the severity of mucosal lesions of the duodenum descending portion in the diagnosis of Henoch-Schnlein purpura. Methods To collect the situation of purpura from the medical history and the degree of mucosal lesions and the immunofluorescence results of duodenum under endoscopic examination. The hyperemia and edema of mucosal were defined as mild lesions, the erosion and ulcer were defined as moderate to severe lesions observed under the endoscopy. The typical skin purpura appeared before the examination of gastroscopy was named as early onset purpura, and after that was named as later onset purpura. According to the results of immunofluorescence test was divided into negative and positive. Results The newly diagnosed Henoch- Schnlein purpura or suspected Henoch- Schnlein purpura patients with the main symptom of abdominal pain were collected who were treated in Department of Gastroenterology of Children's Hospital of Fudan University from April 2014 to December 2015. Fifity- four cases who finished the gastroscopic examination and immunofluorescence test of duodenum portion mucosal were enrolled in the study. Thirty- one cases were males and 23 cases were females; the average age was 8.1±2.7 years; 14 cases were outpatient patients, 40 cases were hospitalized patients; 36 patients (76.7%) were with early onset purpura, 18 cases were with later onset purpura. Duodenal mucosal lesions manifested as congestion and edema in 14 cases, manifested as erosion and ulcers in 40 cases (including erosion in 19 cases and ulcers in 21 cases). Thirty- one cases (57.4%) were immunofluorescence positive of duodenal mucosa and negative in 23 cases. The frequency of moderate to severe mucosal lesions was significantly higher in patients with duodenal mucosal immunofluorescence-negative Henoch- Schnlein purpura than that in positive ones (91.3% vs 61.3%, P=0.013). The frequency of mild mucosal lesions in patients with immunofluorescence positive of duodenal mucosa was higher than that with negative on the basis of all the patients with early onset purpura, the difference was statistically significant (χ2=4.241, P=0.039). There was no significant difference of the degree of mucosal lesions of duodenal portion between early or later onset purpura regardless of the result of immunofluorescence positive or negative of duodenal descending portion mucosal. There was no significant difference in the proportion of mucosal mild lesions with later onset purpura between immunofluorescence positive and negative of duodenal descending portion mucosal. There was no statistically significant difference in the proportion of moderate to severe lesions between patients with early onset purpura and patients with later onset purpura regardless of the result of immunofluorescence positive or negative of duodenal descending portion mucosal. Conclusion Clinical diagnosis of Henoch- Schnlein purpura with negative results of mucosal immunofluorescence should be cautious. It may be mainly associated with the severity of the lesion and can't rule out the biopsy factors, such as location, quantity, depth and equipment.