Henoch Schonlein Purpurası Tanılı Çocuk Hastalarda Kardiyak Etkilenme Sıklığı

Abstract

Amaç: Henoch-Schonlein purpurası (HSP) çocukluk çağının en sık görülen vaskülitidir. Bu çalışmanın amacı HSP’li çocuklarda kardiyovasküler sistemin etkilenme sıklığı ve tipinin araştırılmasıdır.

Araçlar ve Yöntem: Bu çalışmaya HSP tanısı alan 38 hasta ve kontrol grubu olarak 20 sağlıklı çocuk dâhil edildi. Hasta ve kontrol grubuna alınan olgular fizik muayene, elektrokardiyografi (EKG), ekokardiyografi (EKO) ve 24 saatlik EKG izlemi (Holter izlemi) ile değerlendirildi.

Bulgular: Hasta grubunda yaş ortalaması 9.3±3.2 yıl (aralık 4-17 yıl) idi. Hastaların 22’si kız hasta (%57.8) olup kız/erkek oranı 1.37 idi. Kontrol grubunda yaş ortalaması 9.7±3 yıl (aralık 4-14 yıl) idi. Kontrol grubunun 8’i kız (%40) olup kız/erkek oranı 0.66 idi. Henoch-Schonlein purpurası tanılı hastalarda cilt tutulumu %100, eklem tutulumu %71, gastrointestinal sistem tutulumu %71, böbrek tutulumu %31 oranında görüldü. Hasta grubunda EKG’de belirlenen kalp hızı ortalaması kontrol grubuna göre anlamlı olarak yüksekti (p=0.03). Hasta grubunun EKO incelemelerinde ortalama maksimum aort kapak akım hızı (AOVmax.) ve ortalama maksimum pulmoner kapak akım hızı (PULMmax.) değerleri kontrol grubuna göre anlamlı olarak düşüktü (p=0.02, p=0.03). Fakat iki grup arasında sistolik ve diyastolik kardiyak fonksiyonlar açısından anlamlı bir fark yoktu (p>0.05). Hasta grubunda bir hastada minimal perikardiyal efüzyon tespit edildi. Holter izleminde hasta ve kontrol grubunda kalp hızı ortalama değerleri (p=0.79) ve kalp hızı değişkenliği ortalama değerleri açısından anlamlı bir fark yoktu (p=0.60, p=0.57). Ayrıca her iki grupta klinik açıdan önemli bir aritmi veya iletim bozukluğu tespit edilmedi.

Sonuç: Henoch-Schonlein purpurası tanılı hasta grubunda kardiyak etkilenme sık değildir. Hastalar kardiyak etkilenmeye işaret edebilecek klinik bulgular var ise EKO ile değerlendirilebilir. 

Keywords

• çocuk
• henoch-schonlein purpurası
• kardiyak etkilenme

The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura

Abstract

Purpose: Henoch-Schonlein purpura (HSP) is the most common vasculitis in childhood. The aim of this study was to determine the prevalence and type of cardiac involvement in HSP.

Materials and Methods: Thirty-eight children with HSP (patient group) and 20 healthy children (control group) were included in the study. Physical examination, electrocardiography (ECG), echocardiography (ECHO), and 24-hour ECG monitoring (Holter monitoring) were performed.

Results: The mean age of patient and control groups were 9.3±3.2 years (range: 4-17 years) and 9.7±3 years (range: 4-14 years), respectively. Also, the female to male ratios were 1.37 and 0.66, respectively. The percentages of involvement of systems and organs were as follows: skin 100%, joint 71%, gastrointestinal system 71%, and kidney 31%. The mean heart rate (MHR) in ECG was significantly higher in the patient group (p=0.03). The mean values of maximum aortic valve velocity (AOVmax.) and maximum pulmonary valve velocity (PULMVmax.) were significantly lower in the patient group than the control group (p=0.02, p=0.03) in the ECHO examination. However, systolic and diastolic cardiac functions were similar between the groups (p>0.05). In the patient group minimal pericardial effusion was detected in only one case. In 24-hour Holter monitoring MHR values (p=0.79) and heart rate variability parameters were similar between the patient and control groups (p=0.60, p=0.57). Also, no clinically important arrhythmia and other conduction disorders were detected in both groups.

Conclusion: Cardiac involvement in patients with HSP is not common. The patients may be assessed with the ECHO if signs and symptoms related to cardiac involvement were observed. 

Keywords

• child
• henoch-schonlein purpura
• cardiac involvement

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