Guidelines for the diagnosis and management of childhood immunoglobulin A vasculitis.

IF 4.5 2区 医学 Q1 PEDIATRICS
Lan-Jun Shuai, Qiu-Ye Zhang, Xiao-Zhong Li, Zan-Hua Rong, Guang-Min Nong, Tao Wang, Jin-Hai Ma, Yan-Ming Lu, Dong-Mei Zhao, Xiao-Qing Li, Xue-Mei Tang, Wei Zhang, Si-Rui Yang, Liang-Zhong Sun, Hai-Guo Yu, Wei Zhou, Sheng Hao, Jun Yang, Hua-Wei Mao, Ji-Hong Xiao, Ya-Jun Wang, Jian-Jiang Zhang, Tian Shen, Ying Wang, Yao-Long Chen, Hui Liu, Ya-Jia Sun, Yong-Zhen Li, Hong-Mei Song, Xiao-Chuan Wu
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引用次数: 0

Abstract

Background: Immunoglobulin A vasculitis (IgAV) is the most common cause of systemic vasculitis in childhood. Due to the continued use of the disease name "anaphylactoid purpura" in China, several misunderstandings have arisen in clinical practice and treatment regimens differ widely. In addition, new research and evidence-based data have grown. The Subspecialty Group of Immunology, Society of Pediatrics, Chinese Medical Association and the Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases initiated an update of guidelines for the diagnosis and management of childhood IgAV. The aim therefore was to provide agreed consensus recommendations for diagnosis and treatment for children with IgAV.

Methods: This study utilized the Delphi technique to develop an evidence-based expert consensus for childhood IgAV. We conducted a systematic literature review to retrieve evidence, which was graded using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Two rounds of Delphi voting and a consensus meeting involving 23 experts were conducted. Recommendations were accepted when ≥ 75% of experts agreed.

Results: In total, five recommendations for diagnosis, six for treatment, one for prognosis, and two for health education for pediatric IgAV were accepted. Diagnostic recommendations included the use of the European Alliance of Associations for Rheumatology/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society-endorsed Ankara 2008 classification criteria for IgAV diagnosis. In addition, appropriate use of imaging, gastrointestinal endoscopy, skin biopsy, and kidney biopsy are recommended. Kidney biopsy is recommended for children with IgAV presenting with nephrotic syndrome/nephrotic-range proteinuria, reduced estimated glomerular filtration rate, acute nephritis syndrome, or persistent moderated/mild proteinuria. Treatment recommendations involved indications for glucocorticoid use, immunosuppressant use, and intravenous immunoglobulin use. It also addressed the inappropriate use of prophylactic glucocorticoid treatment and recommended against routine employment of plasmapheresis. Health education placed emphasis on the inappropriate use of anti-anaphylactic treatment and proffers dietary suggestions.

Conclusions: This guideline provides evidence-based recommendations for the diagnosis and management of IgAV in children. This will facilitate improved and standardized care.

儿童免疫球蛋白A血管炎的诊断和治疗指南。
背景:免疫球蛋白A血管炎(IgAV)是儿童全身性血管炎的最常见原因。由于“过敏性紫癜”这一疾病名称在中国的持续使用,在临床实践中产生了一些误解,治疗方案差异很大。此外,新的研究和基于证据的数据也在增长。儿科学学会、中华医学会和中国儿科风湿病和免疫疾病联盟的免疫学亚专科小组发起了儿童IgAV诊断和治疗指南的更新。因此,目的是为IgAV儿童的诊断和治疗提供商定的共识建议。方法:本研究利用德尔菲技术建立儿童IgAV循证专家共识。我们进行了系统的文献综述来检索证据,并使用GRADE(推荐评估、发展和评价分级)标准对其进行分级。进行了两轮德尔菲投票和23名专家的共识会议。当≥75%的专家同意时,建议被接受。结果:共接受5项诊断建议、6项治疗建议、1项预后建议和2项儿童IgAV健康教育建议。诊断建议包括使用欧洲风湿病协会联盟/儿科风湿病国际试验组织/儿科风湿病欧洲学会认可的IgAV诊断的安卡拉2008分类标准。此外,建议适当使用影像学检查、胃肠内窥镜检查、皮肤活检和肾活检。对于表现为肾病综合征/肾范围蛋白尿、肾小球滤过率降低、急性肾炎综合征或持续性中度/轻度蛋白尿的IgAV患儿,建议进行肾活检。治疗建议包括使用糖皮质激素、使用免疫抑制剂和静脉注射免疫球蛋白的适应症。它还指出了预防性糖皮质激素治疗的不当使用,并建议反对血浆置换的常规使用。健康教育强调抗过敏治疗的不当使用,并提供饮食建议。结论:本指南为儿童IgAV的诊断和治疗提供了循证建议。这将有助于改善和标准化护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Pediatrics
World Journal of Pediatrics 医学-小儿科
CiteScore
10.50
自引率
1.10%
发文量
592
审稿时长
2.5 months
期刊介绍: The World Journal of Pediatrics, a monthly publication, is dedicated to disseminating peer-reviewed original papers, reviews, and special reports focusing on clinical practice and research in pediatrics. We welcome contributions from pediatricians worldwide on new developments across all areas of pediatrics, including pediatric surgery, preventive healthcare, pharmacology, stomatology, and biomedicine. The journal also covers basic sciences and experimental work, serving as a comprehensive academic platform for the international exchange of medical findings.
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