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Henoch Schonlein Purpurası Tanılı Çocuk Hastalarda Kardiyak Etkilenme Sıklığı

Yıl 2022, Cilt: 6 Sayı: 2, 121 - 125, 30.08.2022

Ferat Balkır Naci Ceviz Fuat Laloğlu Haşim Olgun

https://doi.org/10.46332/aemj.909960

Öz

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. 

Anahtar Kelimeler

çocuk henoch-schonlein purpurası kardiyak etkilenme

Kaynakça

  • 1. Ardoin SP, Fels E. Vasculitis Syndromes. Kliegman RM, Stanton BF, Schor NF, St. Geme III JW, Behrman RE, eds. Nelson Textbook of Pediatrics. 19. ed. Philadelphia: Elsevier Saunders; 2011:867-871.
  • 2. Yalcindag A, Sundel R. Vasculitis in childhood. Curr Opin Rheumatol. 2001;13(5):422-427.
  • 3. Cassidy JT, Petty RE. Vasculitis and its classification. Cassidy JT, Petty RE, Laxer RM, Lindsley CB, eds. Textbook of Pediatric Rheumatology. 5. ed. Philadelphia: Elsevier Saunders; 2005:492-496.
  • 4. Agraharkar M, Gokhale S, Le L, Rajaraman S, Campbell GA. Cardiopulmonary manifestations of HenochSchonlein purpura. Am J Kidney Dis. 2000;35(2):319- 322.
  • 5. Osman A, McCreery CJ. Cardiac vasculitis in HenochSchonlein purpura. Circulation. 2000;101(5):e69-70.
  • 6. Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19(12):1413- 1430.
  • 7. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713.
  • 8. Park MK, Guntheroth WG. How to Read Pediatric ECGs. 4. ed. Philadelphia: Mosby Elsevier; 2006.
  • 9. Polizzotto MN, Gibbs SD, Beswick W, Seymour JF. Cardiac involvement in Henoch-Schonlein purpura. Intern Med J. 2006;36(5):328-331.
  • 10. Carmichael P, Brun E, Jayawardene S, Abdulkadir A, O'Donnell PJ. A fatal case of bowel and cardiac involvement in Henoch-Schonlein purpura. Nephrol Dial Transplant. 2002;17(3):497-499.
  • 11. Kereiakes DJ, Ports TA, Finkbeiner W. Endomyocardial biopsy in Henoch-Schonlein purpura. Am Heart J. 1984;107(2):382-385.
  • 12. Abdel-Hadi O, Greenstone MA, Hartley RB, Kidner PH. Myocardial infarction-a rare complication in Henoch-Schonlein purpura. Postgrad Med J. 1981;57(668):390-392.
  • 13. Satoh M, Mikuniya A, Mikami M, et al. [A case of Schonlein-Henoch purpura with myocardial complications]. Kokyu To Junkan. 1991;39(3):273-277.
  • 14. Lutz HH, Ackermann T, Krombach GA, et al. HenochSchonlein purpura complicated by cardiac involvement: case report and review of the literature. Am J Kidney Dis. 2009;54(5):e9-15.
  • 15. Canpolat U, Yorgun H, Sahiner L, Kabakci G. Myocardial infarction due to coronary thrombosis in a patient with Henoch-Schonlein purpura. Herz. 2012;37(7):801-803.
  • 16. Gulati T, Kumar P, Dewan V, Anand VK. Henoch schonlein purpura with rheumatic carditis. Indian J Pediatr. 2004;71(4):371-372.
  • 17. Guven H, Ozhan B, Bakiler AR, Salar K, Kozan M, Bilgin S. A case of Henoch-Schonlein purpura and rheumatic carditis with complete atrioventricular block. Eur J Pediatr. 2006;165(6):395-397.
  • 18. Veetil BM, Reed AM, Mattke AC. Coronary artery thickening with mucosal lesions in Henoch-Schonlein purpura. Pediatr Dermatol. 2012;29(3):377-378.
  • 19. Kalyoncu M, Cakir M, Erduran E, Okten A. HenochSchonlein purpura: a case with atypical presentation. Rheumatol Int. 2006;26(7):669-671.
  • 20. Migita M, Hayakawa J, Shima H, et al. A case of Henoch-Schonlein purpura with rare complications: necrosis of the small intestine, neurological symptoms, and pericardial tamponade. J Nippon Med Sch. 2005;72(6):383-386.
  • 21. Zaidi M, Singh N, Kamran M, Ansari N, Nasr SH, Acharya A. Acute onset of hematuria and proteinuria associated with multiorgan involvement of the heart, liver, pancreas, kidneys, and skin in a patient with Henoch-Schonlein purpura. Kidney Int. 2008;73(4):503-508.
  • 22. Meadow SR, Glasgow EF, White RH, Moncrieff MW, Cameron JS, Ogg CS. Schonlein-Henoch nephritis. Q J Med. 1972;41(163):241-242.

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

Yıl 2022, Cilt: 6 Sayı: 2, 121 - 125, 30.08.2022

Ferat Balkır Naci Ceviz Fuat Laloğlu Haşim Olgun

https://doi.org/10.46332/aemj.909960

Öz

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. 

Anahtar Kelimeler

child henoch-schonlein purpura cardiac involvement

Kaynakça

  • 1. Ardoin SP, Fels E. Vasculitis Syndromes. Kliegman RM, Stanton BF, Schor NF, St. Geme III JW, Behrman RE, eds. Nelson Textbook of Pediatrics. 19. ed. Philadelphia: Elsevier Saunders; 2011:867-871.
  • 2. Yalcindag A, Sundel R. Vasculitis in childhood. Curr Opin Rheumatol. 2001;13(5):422-427.
  • 3. Cassidy JT, Petty RE. Vasculitis and its classification. Cassidy JT, Petty RE, Laxer RM, Lindsley CB, eds. Textbook of Pediatric Rheumatology. 5. ed. Philadelphia: Elsevier Saunders; 2005:492-496.
  • 4. Agraharkar M, Gokhale S, Le L, Rajaraman S, Campbell GA. Cardiopulmonary manifestations of HenochSchonlein purpura. Am J Kidney Dis. 2000;35(2):319- 322.
  • 5. Osman A, McCreery CJ. Cardiac vasculitis in HenochSchonlein purpura. Circulation. 2000;101(5):e69-70.
  • 6. Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19(12):1413- 1430.
  • 7. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713.
  • 8. Park MK, Guntheroth WG. How to Read Pediatric ECGs. 4. ed. Philadelphia: Mosby Elsevier; 2006.
  • 9. Polizzotto MN, Gibbs SD, Beswick W, Seymour JF. Cardiac involvement in Henoch-Schonlein purpura. Intern Med J. 2006;36(5):328-331.
  • 10. Carmichael P, Brun E, Jayawardene S, Abdulkadir A, O'Donnell PJ. A fatal case of bowel and cardiac involvement in Henoch-Schonlein purpura. Nephrol Dial Transplant. 2002;17(3):497-499.
  • 11. Kereiakes DJ, Ports TA, Finkbeiner W. Endomyocardial biopsy in Henoch-Schonlein purpura. Am Heart J. 1984;107(2):382-385.
  • 12. Abdel-Hadi O, Greenstone MA, Hartley RB, Kidner PH. Myocardial infarction-a rare complication in Henoch-Schonlein purpura. Postgrad Med J. 1981;57(668):390-392.
  • 13. Satoh M, Mikuniya A, Mikami M, et al. [A case of Schonlein-Henoch purpura with myocardial complications]. Kokyu To Junkan. 1991;39(3):273-277.
  • 14. Lutz HH, Ackermann T, Krombach GA, et al. HenochSchonlein purpura complicated by cardiac involvement: case report and review of the literature. Am J Kidney Dis. 2009;54(5):e9-15.
  • 15. Canpolat U, Yorgun H, Sahiner L, Kabakci G. Myocardial infarction due to coronary thrombosis in a patient with Henoch-Schonlein purpura. Herz. 2012;37(7):801-803.
  • 16. Gulati T, Kumar P, Dewan V, Anand VK. Henoch schonlein purpura with rheumatic carditis. Indian J Pediatr. 2004;71(4):371-372.
  • 17. Guven H, Ozhan B, Bakiler AR, Salar K, Kozan M, Bilgin S. A case of Henoch-Schonlein purpura and rheumatic carditis with complete atrioventricular block. Eur J Pediatr. 2006;165(6):395-397.
  • 18. Veetil BM, Reed AM, Mattke AC. Coronary artery thickening with mucosal lesions in Henoch-Schonlein purpura. Pediatr Dermatol. 2012;29(3):377-378.
  • 19. Kalyoncu M, Cakir M, Erduran E, Okten A. HenochSchonlein purpura: a case with atypical presentation. Rheumatol Int. 2006;26(7):669-671.
  • 20. Migita M, Hayakawa J, Shima H, et al. A case of Henoch-Schonlein purpura with rare complications: necrosis of the small intestine, neurological symptoms, and pericardial tamponade. J Nippon Med Sch. 2005;72(6):383-386.
  • 21. Zaidi M, Singh N, Kamran M, Ansari N, Nasr SH, Acharya A. Acute onset of hematuria and proteinuria associated with multiorgan involvement of the heart, liver, pancreas, kidneys, and skin in a patient with Henoch-Schonlein purpura. Kidney Int. 2008;73(4):503-508.
  • 22. Meadow SR, Glasgow EF, White RH, Moncrieff MW, Cameron JS, Ogg CS. Schonlein-Henoch nephritis. Q J Med. 1972;41(163):241-242.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Bilimsel Araştırma Makaleleri
Yazarlar

Ferat Balkır Bu kişi benim 0000-0002-6010-0551

Naci Ceviz 0000-0002-2911-6483

Fuat Laloğlu 0000-0003-1595-4723

Haşim Olgun Bu kişi benim 0000-0001-8440-2880

Erken Görünüm Tarihi 16 Ağustos 2022
Yayımlanma Tarihi 30 Ağustos 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 6 Sayı: 2

Kaynak Göster

APA Balkır, F., Ceviz, N., Laloğlu, F., Olgun, H. (2022). The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura. Ahi Evran Medical Journal, 6(2), 121-125. https://doi.org/10.46332/aemj.909960
AMA Balkır F, Ceviz N, Laloğlu F, Olgun H. The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura. Ahi Evran Med J. Ağustos 2022;6(2):121-125. doi:10.46332/aemj.909960
Chicago Balkır, Ferat, Naci Ceviz, Fuat Laloğlu, ve Haşim Olgun. “The Frequency of Cardiac Involvement in Children With Henoch-Schonlein Purpura”. Ahi Evran Medical Journal 6, sy. 2 (Ağustos 2022): 121-25. https://doi.org/10.46332/aemj.909960.
EndNote Balkır F, Ceviz N, Laloğlu F, Olgun H (01 Ağustos 2022) The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura. Ahi Evran Medical Journal 6 2 121–125.
IEEE F. Balkır, N. Ceviz, F. Laloğlu, ve H. Olgun, “The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura”, Ahi Evran Med J, c. 6, sy. 2, ss. 121–125, 2022, doi: 10.46332/aemj.909960.
ISNAD Balkır, Ferat vd. “The Frequency of Cardiac Involvement in Children With Henoch-Schonlein Purpura”. Ahi Evran Medical Journal 6/2 (Ağustos 2022), 121-125. https://doi.org/10.46332/aemj.909960.
JAMA Balkır F, Ceviz N, Laloğlu F, Olgun H. The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura. Ahi Evran Med J. 2022;6:121–125.
MLA Balkır, Ferat vd. “The Frequency of Cardiac Involvement in Children With Henoch-Schonlein Purpura”. Ahi Evran Medical Journal, c. 6, sy. 2, 2022, ss. 121-5, doi:10.46332/aemj.909960.
Vancouver Balkır F, Ceviz N, Laloğlu F, Olgun H. The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura. Ahi Evran Med J. 2022;6(2):121-5.
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