Henoch Schonlein Purpura and Corticosteroid Treatment

新发过敏性紫癜（HSP）患儿是否应该接受全身皮质类固醇治疗，以预防常见的后续并发症，包括肾损伤？对这个问题的严谨回答将具有重大的临床意义。和其他人一样，我们假设皮质类固醇可以改善炎症，加速HSP急性症状的消退，并保护肾脏免受长期损伤。这项拟议的研究将使用从美国30多家儿童医院收集的数据，历时4年。这将是第一个使用倾向评分匹配分析来检查使用或不使用类固醇治疗的患者再入院率的差异，以及需要再入院的合并症的发展，包括肾炎、高血压、复发性腹痛和肠套叠。本研究的数据将阐明糖皮质激素对住院HSP患者的影响，并将为未来临床研究的设计提供信息。我们的具体目标是：1)描述儿童HSP的临床管理，具体评估不同表现的HSP患者皮质类固醇治疗的使用和时机，并检查不同医院皮质类固醇使用的差异。2)比较接受支持性护理与皮质类固醇治疗的HSP儿童的结局，并调整（通过倾向评分匹配）接受皮质类固醇治疗的可能性。3)通过确定初次入院和随后再入院期间皮质激素相关并发症的发生率，确定皮质激素治疗儿童HSP的短期安全性。相关性：HSP是儿童最常见的血管炎，每年影响约8-10万儿童，占美国所有儿童血管炎的49%。这些儿童中约有40%因肾小球肾炎、高血压、顽固性疼痛或胃肠道出血而住院。急性期以后，主要发病为长期肾病。如何最好地治疗急性表现和预防HSP的长期并发症仍然存在争议。改善治疗和预防需要设计更好的回顾性研究，如本文提出的研究，以及更大规模的前瞻性随机对照试验。这些研究可能为支持HSP的早期皮质类固醇治疗提供证据，或者可能更坚定地表明这是改善这些患者预后的无效手段，从而刺激治疗研究的不同方向，可能侧重于其他免疫调节或肾脏保护治疗。

DESCRIPTION: Should children presenting to the hospital with new-onset Henoch Schonlein purpura (HSP) be treated with systemic corticosteroids in order to prevent the common subsequent complications, including renal injury? A rigorous answer to this question would have substantial clinical implications. We hypothesize, as have others, that corticosteroids ameliorate inflammation, hasten the resolution of acute manifestations of HSP, and protect the kidneys from long-term injury. The proposed study will use data collected from more than 30 children's hospitals in the United States over a 4 year period. It will be the first to use propensity score matched analysis to examine the difference between patients treated either with or without steroids in rates of hospital readmission, and development of co-morbidities necessitating readmission including nephritis, hypertension, recurrent abdominal pain, and intussusception. Data from this study will clarify the effect of corticosteroids on patients hospitalized with HSP, and will inform the design of future clinical investigations. We specifically aim to: 1) Describe the prevailing clinical management of children with HSP, specifically assessing the use and timing of corticosteroid treatment for patients with different manifestations of HSP and examining the variation in the use of corticosteroids among hospitals. 2) Compare outcomes of children with HSP who receive supportive care versus corticosteroids, with adjustment (through propensity score matching) for the likelihood of having received corticosteroids. 3) Determine the short-term safety of corticosteroid treatment for children with HSP by determining the rate of corticosteroid-associated complications during the initial admission and any subsequent readmissions. Relevance: HSP is the most common vasculitis of childhood affecting approximately 8-10/100,000 children annually and accounting for 49% of all childhood vasculitides in the United States. Approximately 40% of these children require hospitalization secondary to glomerulonephritis, hypertension, intractable pain or gastointestinal bleeding. Beyond the acute phase the major morbidity is prolonged urenal disease. How best to treat the acute manifestations and prevent the long-term complications of HSP remains controversial. Improvement in therapy and prevention requires better designed retrospective studies, such as the study proposed herein, and larger prospective randomized controlled trials. Such studies may provide evidence in support of early corticosteroid treatment for HSP, or may more firmly reveal this to be an ineffective means to improve these patients' outcomes, and thus spur therapeutic research in a different direction, focusing perhaps on other immunomodulatory or renal-protective treatments.