ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 24 of 60
УЖМБС 2019, 4(6): 171–177
Clinical Medicine

Status of Complement System in Children with Henoch–Schonlein Purpura

Makieieva N. I., Chaika K.

Henoch–Schonlein purpura is an immunopathological disease characterized by systemic inflammation of small blood vessels with the immune complex deposition. Clinical presentation of Henoch–Schonlein purpura is characterized by skin corrosion, joint disease, gastrointestinal tract and kidneys. Nephrotic syndrome occurs in 20–50% of patients and lead to complications. The immunocomplex nature of the disease has been proved, but the question of specific markers of the Henoch–Schonlein purpura remains open. The purpose of the study was to define the components of the complement system and membrane attack complex in children with Henoch–Schonlein purpura as specific markers for the course of the disease. Material and methods. In total, 83 patients with Henoch–Schonlein purpura aged from 2 to 17 years were examined. They were treated at the Kharkiv City Children's Clinical Hospital №16. Patients with Henoch–Schonlein purpura were divided into two groups: group A (n = 58) included patients with Henoch–Schonlein purpura without kidney damage and group B (n = 25) had patients with combination of Henoch–Schonlein purpura and nephrotic syndrome. The control group included 20 healthy children. The routine study methods were conducted, as well as the determination of the level C3, C4 and membrane attack complex in the acute period and in remission. A statistical analysis has been performed using StatSoftSTATISTICA Version 8 (Tulsa, OK). Results and discussion. The Henoch–Schonlein purpura in children was diagnosed to a significant extent at the age of up to 12 years, 86.6% ± 4.3% (p = 0.003). The high criteria H was recorded for the C3 fraction in the acute period and the remission (H = 15.5870, p = 0.0004 and H = 14.5884, p = 0.0007, respectively) and membrane attack complex in the acute period (H = 13.78437, p = 0.001), which reliably points to the difference between median line in all groups. The membrane attack complex level in blood serum was significantly increased in the acute group A and B in the acute phase compared with the control group (PAC = 0.0000; PBC = 0.0002) and remained significantly higher in both groups compared to the control group during the remission period (PAC = 0.0001; PBC = 0.0002). The C3 fractions level did not change in dynamics in both groups A and B (T = 204.5, p = 0.3940 and T = 44.0, p = 0.9165, respectively). Compared to the acute period, the level of C4 was significantly lower in remission in both groups A and B (T = 144.0, p = 0.0415 and T = 10.5, p = 0.0253, respectively). During the remission period, there was a significant reduction in blood serum membrane attack complex level in the group A (T = 47.0, p = 0.0235), in the group B the level of membrane attack complex also tended to decrease, but it wasn’t reliably recorded. Conclusions. Reduction of C3 components level of the complement system was significantly reduced in the acute phase in cases with / without kidney involvement, indicating that hypocomplementemia is independent of the severity of the Henoch–Schonlein purpura process. And, arise in the level of membrane attack complex, regardless of patient groups, also suggests that the complement system is activated equally in processes without and with the involvement of the kidneys.

Keywords: Henoch–Schonlein purpura, complement system, membrane attack complex, kidneys, children

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