Henoch Schonlein Purpura and Corticosteroid Treatment

描述：到医院就诊的新发过敏性紫癜(HSP)的儿童是否应该接受全身皮质类固醇治疗，以防止常见的后续并发症，包括肾脏损伤？对这个问题的严格回答将具有重大的临床意义。我们假设，与其他人一样，皮质类固醇可以减轻炎症，加速HSP急性症状的解决，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，为期4年。这将是第一次使用倾向分数匹配分析来检查接受或不接受类固醇治疗的患者在再次住院率以及包括肾炎、高血压、反复腹痛和肠套叠在内的需要再次住院的共病发展方面的差异。这项研究的数据将阐明皮质类固醇对HSP住院患者的影响，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)描述目前儿童过敏症的临床治疗，特别是评估对不同表现的过敏性紫杉醇患者使用皮质类固醇治疗的使用和时机，并检查不同医院使用皮质类固醇的差异。2)比较接受支持性治疗和皮质类固醇治疗的HSP儿童的结果，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)通过测定首次入院和随后再入院期间皮质类固醇相关并发症的发生率，确定糖皮质激素治疗HSP儿童的短期安全性。相关：HSP是最常见的儿童脉管炎，每年影响大约8-10/100,000名儿童，占美国所有儿童脉管炎的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需要住院治疗。在急性期之后，主要的发病率是延迟性尿道病。如何更好地治疗HSP的急性表现和预防远期并发症仍存在争议。在治疗和预防方面的改进需要设计更好的回溯性研究，如本文建议的研究，以及更大规模的前瞻性随机对照试验。这类研究可能会提供证据支持早期皮质类固醇治疗HSP，或者更确切地表明，这是改善这些患者预后的无效手段，从而刺激治疗研究朝着不同的方向发展，可能集中在其他免疫调节或肾脏保护治疗上。

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.