Ig-A vasküliti (Henoch-Schönlein purpurası) Tanısı Alan Çocuklarda Trombosit İndekslerinin Klinik Önemi

Öz

Amaç: Ig-A vasküliti, çoğunlukla kendi kendini sınırlayan, cilt, eklem, gastrointestinal sistem ve böbrek tutulumu ile karakterize, çocukluk çağı sistemik vaskülitinin en yaygın şeklidir. Biz bu çalışmada, Ig-A vaskülitli hastaların demografik özelliklerini, klinik ve laboratuvar bulgularını ve bunların trombosit indeksleri ile ilişkisini araştırmayı amaçladık.

Gereç ve Yöntem: Çocuk Acil kliniğine başvuran, Ig-A vasküliti tanısı almış hastaların kayıtları retrospektif olarak incelendi. Hastaların yaş, cinsiyet, başvuru şikayeti, klinik ve laboratuvar bulguları kayıt edildi. Sağlam çocuk polikliniğine başvuran yaş ve cinsiyet eşleştirmesi yapılmış 48 sağlıklı çocuk kontrol grubu olarak kabul edildi.

Bulgular: Ig-A vasküliti tanısı alan 48 hastanın 33’ü (%68,8) cilt döküntüsü, 11’i (%22,9) eklem ağrısı ya da şişliği ve dördü (%8,3) karın ağrısı şikayeti ile başvurdu. Takiplerinde hastaların tamamında klasik Ig-A vasküliti döküntüsü ortaya çıktı. 38’inde (%79,2) eklem, 16’sında (%33,3) gastrointestinal sistem ve altısında (%12,5) böbrek tutulumu vardı. Böbrek tutulumu olan altı hastanın tamamının istatistiksel anlamlı olarak (p: 0,024) erkek olduğu tespit edildi. Laboratuvar bulguları karşılaştırıldığında kontrol grubuna göre trombosit sayısının hasta grubunda istatistiksel anlamlı olarak (p: 0,001) yüksek olduğu, ortalama trombosit hacminin ise hasta grubunda istatistiksel anlamlı olarak (p: 0,001) düşük olduğu tespit edildi. Yine C-reaktif protein ve eritrosit sedimentasyon hızının  hasta grubunda kontrol grubuna oranla istatistiksel anlamlı olarak (p: 0,001) yüksek olduğu tespit edildi.

Sonuç: Çalışmazda ortalama trombosit hacmi Ig-A vaskülitli hastalarda sağlam kontrollere oranla düşük tespit edildi. Ig-A vasküliti  tanısı alan çocuklarda trombosit indekslerinin klinik öneminin anlaşılması için daha geniş ve çok merkezli çalışmalara ihtiyaç vardır. 

Anahtar Kelimeler

• Ig-A vasküliti,çocuk,trombosit indeksleri

Clinical Importance of Platelet Indices in Children with Ig-A Vasculitis (Henoch-Schönlein Purpura)

Öz

Aim: Ig-A vasculitis (IgAV) is the most common form of systemic vasculitis in children, characterized by self-limiting skin, joint, gastrointestinal, and kidney involvement. In this study, we aimed to investigate clinical, demographic and laboratory characteristics of patients with IgAV, and evaluate their association with platelet indices.

Materials and Methods: The records of patients who admitted to the pediatric emergency clinic and diagnosed as IgAV were reviewed retrospectively. Patients' age, gender, complaints, clinical and laboratory findings were recorded. 48 age- and sex-matched healthy children who had admitted to a healthy child polyclinic were included as the control group.

Results: 48 patients were diagnosed as IgAV. 33 (68.8%) of the patients admitted with skin rash, 11 (22.9%) with joint pain or swelling, and four (8.3%) with abdominal pain. All of the patients developed classic IgAV rash during follow-up. Joint, gastrointestinal system and renal involvement was observed in 38 (79.2%), 16 (33.3%) and 6 (12.5%) of the patients, rspectively. All of the six patients with renal involvement were male, which was statistically significant (p: 0.024). When hemogram results were compared PLT levels were found to be significantly (p: 0.001) higher and MPV levels significantly lower (p: 0.001) in the patient group than the controls. The mean CRP and ESR levels were found to be significantly (p: 0.001) higher in the patient group.

Conclusion: MPV levels were significantly lower in patients with IgAV. There is a need for wider and multicentered prospective studies to explain the clinical importance of platelet indices in patients with IgAV.

Anahtar Kelimeler

• Ig-A vasculitis,child,platelet indices

Kaynakça

1. referans 5: Levy M, Broyer M, Arsan A, Levy-Bentolila D, Habib R. Anaphylactoid purpura nephritis in childhood: natural history and immunopathology. Adv Nephrol Necker Hosp 1976;(6):183-228.
2. referans 10: Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14(1):28-32.
3. referans 6: Yang YH, Yu HH, Chiang BL. The diagnosis and classification of Henoch-Schönlein purpura: an updated review. Autoimmun Rev 2014;13(4-5):355-58.
4. referans 7: Calviño MC, Llorca J, García-Porrúa C, Fernández-Iglesias JL, Rodriguez-Ledo P, González-Gay MA. Henoch-Schönlein purpura in children from northwestern Spain:a 20-year epidemiologic and clinical study. Medicine (Baltimore) 2001;80(5):279-90.
5. referans 8: Evans-Jones LG, Clough JV. Thrombocytosis in Henoch-Schonlein syndrome. Clin Lab Haematol 1990;12(2):137-9.
6. referans 9: Jagroop IA, Clatworthy I, Lewin J, Mikhailidis DP. Shape change in human platelets: measurement with a channelyzer and visualisation by electron microscopy. Platelets 2000;11(1):28-32.
7. referans 11: Hoffmann JJ. Reference range of mean platelet volume. Thromb Res 2012;129(4):534-35.
8. referans 12: Kuter DJ. The physiology of platelet production. Stem Cells 1996;14 (1):88-101.

9. referans 13: Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17(1):47-58.
10. referans 14: Jauhola O, Ronkainen J, Koskimies O, et al. Clinical course of extrarenal symptoms in Henoch-Schonlein purpura: a 6-month prospective study. Arch Dis Child 2010;95(11):871-76.
11. referans 19: Benzer M, Duramaz B, Önal Z, Akyol M, Bülbül L, Hatipoğlu S. clinical importance of mean platelet volume in children diagnosed with Henoch-schönlein purpura (Ig-A vasculitis). Marmara Med. J 2015; 28: 151-156
12. referans 15: Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005;35(3):143-53.
13. referans 16: Ghrahani R, Ledika MA, Sapartini G, Setiabudiawan B. Age of onset as a risk factor of renal involvement in Henoch-Schönlein purpura. Asia Pac Allergy 2014;4(1):42-47.
14. referans 17: Öztürk ZA, Dag MS, Kuyumcu ME, et al. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci 2013;17(3):334-41.
15. referans 18: Bilici S, Sekmenli T, Göksu M, Melek M, Avci V. Mean platelet volume in diagnosis of acute appendicitis in children. Afr Health Sci 2011;11(3):427-32.
16. referans 1: Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013;65(1):1-11.
17. referans 20: Bağ Ö, Karaarslan U, Ecevit Ç, Kanberoğlu Gİ, Öztürk A. The Value of Platelet Indices in Henoch-Schonlein Purpura. Ann Paediatr Rheum 2014;3(3):126-31.
18. referans 21: Maluf CB, Barreto SM, Vidigal PG. Standardization and reference intervals of platelet volume indices: Insight from the Brazilian longitudinal study of adult health (ELSA-BRASIL). Platelets 2015;26(5):413-20.
19. referans 22: Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population-based platelet reference values for an Iranian population. Int J Lab Hematol 2007;29(3):195-99.
20. referans 23: Günay KHYÜL, Irmak F. Tam kan bekleme süresinin trombosit indekslerine etkisi. Türk Klinik Biyokimya Derg 2016; 14(1): 26-31
21. referans 2: Piram M, Mahr A. Epidemiology of immunoglobulin A vasculitis(Henoch-Schönlein): current state of knowledge. Curr Opin Rheumatol 2013;25(2):171-8.
22. referans 3: Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002;360(9341):1197-202.
23. referans 4: Piram M, Maldini C, Biscardi S,et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study. Rheumatology (Oxford) 2017;56(8):1358-66.