血液灌流治疗儿童重症腹型过敏性紫癜的临床疗效和机制探讨
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摘要
目的观察血液灌流(HP)治疗儿童重症腹型过敏性紫癜(HSP)的疗效并初步探讨其机制。方法 24例重症腹型HSP患儿分为常规治疗组(12例)和血液灌流组(12例),并以10例健康体检儿童作为对照组。采用化学发光法检测对照组以及两个治疗组治疗前后的血清白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平,以及硫代巴比妥酸比色法检测血浆丙二醛(MDA)水平,羟胺法检测血浆超氧化物歧化酶(SOD)水平,化学比色法检测血浆总抗氧化能力(T-AOC)。结果与健康组比,常规组及HP组治疗前的IL-6、TNF-α、MDA明显增多,SOD、T-AOC明显下降(P<0.05),但常规组及HP组之间的差异无统计学意义(P>0.05);与治疗前比较,治疗后常规组及HP组患儿的IL-6、TNF-α、MDA水平均下降,SOD、T-AOC均回升,差异均有统计学意义(P<0.05),而且HP组变化较常规组更显著,但与健康组相比差异仍有统计学意义(P<0.05)。与HP组比较,治疗后第4天常规组消化道症状控制的比例较低,皮疹和消化道症状控制所用的时间较长,差异有统计学意义(P<0.05);与常规组比较,HP组激素用量较小,病程6个月内发生血尿和/或蛋白尿的几率小,差异均有统计学意义(P<0.05);两组在住院时间以及病程6个月以内的皮疹、腹痛复发率的差异无统计学意义(P>0.05)。结论 HP可以降低重症腹型HSP患儿激素用量、肾损伤发生几率,机制可能与HP有效清除IL-6、TNF-α、MDA有关。
Objective To study the clinical effect and mechanism of hemoperfusion(HP) in the treatment of children with severe abdominal Henoch-Sch?nlein purpura(HSP). Methods A total of 24 children with severe abdominal HSP were divided into two groups: conventional treatment and HP(n=12 each). Ten healthy children who underwent physical examination were enrolled as the control group. Before and after treatment, chemiluminescence was used to measure the serum levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α); thiobarbituric acid colorimetry was used to measure the plasma level of malondialdehyde(MDA); the hydroxylamine method was used to measure the plasma level of superoxide dismutase(SOD); chemical colorimetry was used to measure the plasma level of total anti-oxidant capability(T-AOC). Results Compared with the control group, the conventional treatment and HP groups had significantly higher IL-6, TNF-α, and MDA levels and significantly lower SOD and T-AOC levels before treatment(P<0.05), but there were no significant differences between the conventional treatment and HP groups(P>0.05). After treatment, the conventional treatment and HP groups had significant reductions in IL-6, TNF-α, and MDA levels and significant increases in SOD and T-AOC levels(P<0.05). The HP group had significantly greater changes than the conventional treatment group; however, there were still significant differences in these indices between the HP and control groups(P<0.05). Compared with the HP group, the conventional treatment group had a significantly lower percentage of children with disappearance of digestive tract symptoms at 4 days after treatment and significantly longer time to disappearance of rash and digestive tract symptoms(P<0.05). Compared with the conventional treatment group, the HP group had a significantly lower amount of glucocorticoid used during treatment and a significantly lower percentage of children who experienced hematuria and/or proteinuria within 6 months of the disease course(P<0.05). There were no significant differences between the two groups in length of hospital stay and recurrence rates of rash and abdominal pain within 6 months of the disease course. Conclusions HP can reduce the amount of glucocorticoid used during treatment and the incidence rate of kidney injury in children with severe abdominal HSP, possibly by eliminating IL-6, TNF-α, and MDA.
Objective To study the clinical effect and mechanism of hemoperfusion(HP) in the treatment of children with severe abdominal Henoch-Sch?nlein purpura(HSP). Methods A total of 24 children with severe abdominal HSP were divided into two groups: conventional treatment and HP(n=12 each). Ten healthy children who underwent physical examination were enrolled as the control group. Before and after treatment, chemiluminescence was used to measure the serum levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α); thiobarbituric acid colorimetry was used to measure the plasma level of malondialdehyde(MDA); the hydroxylamine method was used to measure the plasma level of superoxide dismutase(SOD); chemical colorimetry was used to measure the plasma level of total anti-oxidant capability(T-AOC). Results Compared with the control group, the conventional treatment and HP groups had significantly higher IL-6, TNF-α, and MDA levels and significantly lower SOD and T-AOC levels before treatment(P<0.05), but there were no significant differences between the conventional treatment and HP groups(P>0.05). After treatment, the conventional treatment and HP groups had significant reductions in IL-6, TNF-α, and MDA levels and significant increases in SOD and T-AOC levels(P<0.05). The HP group had significantly greater changes than the conventional treatment group; however, there were still significant differences in these indices between the HP and control groups(P<0.05). Compared with the HP group, the conventional treatment group had a significantly lower percentage of children with disappearance of digestive tract symptoms at 4 days after treatment and significantly longer time to disappearance of rash and digestive tract symptoms(P<0.05). Compared with the conventional treatment group, the HP group had a significantly lower amount of glucocorticoid used during treatment and a significantly lower percentage of children who experienced hematuria and/or proteinuria within 6 months of the disease course(P<0.05). There were no significant differences between the two groups in length of hospital stay and recurrence rates of rash and abdominal pain within 6 months of the disease course. Conclusions HP can reduce the amount of glucocorticoid used during treatment and the incidence rate of kidney injury in children with severe abdominal HSP, possibly by eliminating IL-6, TNF-α, and MDA.
引文
[1]尹薇,陈晶.儿童过敏性紫癜免疫机制研究[J].中华实用儿科临床杂志,2017,32(21):1604-1607.
[2]钟燕兰,党西强,何小解,等.血液灌流治疗重症过敏性紫癜的疗效及可能机制[J].中华实用儿科临床杂志,2013,28(21):1625-1628.
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[8]Sedaghat Z,Kadkhodaee M,Seifi B,et al.Hind limb preconditioning renoprotection by modulation of inflammatory cytokines after renal ischemia/reperfusion[J].Ren Fail,2016,38(5):655-662.
[9]孙爱玲.过敏性紫癜患儿血清IL-6、IL-8及TNF-α表达的意义[J].中国实用医刊,2011,38(15):26-27.
[10]Ha TS.The role of tumor necrosis factor-alpha in HenochSch?nlein purpura[J].Pediatr Nephrol,2005,20(2):149-153.
[11]Chen T,Guo ZP,Zhang YH,et al.Elevated serum heme oxygenase-1 and insulin-like growth factor-1 levels in patients with Henoch-Sch?nlein purpura[J].Rheumatol Int,2011,31(3):321-326.
[12]李娟,范春燕,吴康.紫癜性肾炎患儿尿中血管紧张素原及丙二醛水平的测定及其临床意义分析研究[J].医学临床研究,2017,34(9):1836-1838.
[13]高岩,邓会英.儿童血液灌流[M]//沈颖,易著文.儿科血液净化技术.北京:清华大学出版社,2012:120-137.
[14]曾萍,洪婕,杨镒宇,等.免疫吸附治疗儿童难治型自身免疫性疾病[J].中华实用儿科临床杂志,2014,29(9):668-671.
[15]Ma DQ,Li Y,Han ZG,et al.Analysis on kidney injury-related clinical risk factors and evaluation on the therapeutic effects of hemoperfusion in children with Henoch-Sch?nlein purpura[J].Eur Rev Med Pharmacol Sci,2017,21(17):3894-3899.
[16]吴小川.儿童过敏性紫癜循证诊治建议解读[J].中华儿科杂志,2013,51(7):508-511.
[2]钟燕兰,党西强,何小解,等.血液灌流治疗重症过敏性紫癜的疗效及可能机制[J].中华实用儿科临床杂志,2013,28(21):1625-1628.
[3]Ba?aran?,Cakar N,Uncu N,et al.Plasma exchange therapy for severe gastrointestinal involvement of Henoch Sch?nlein purpura in children[J].Clin Exp Rheumatol,2015,33(Suppl89):S176-S180.
[4]刘丽,黄燕萍,房夏玲,等.血液灌流治疗对过敏性紫癜患儿血清IL-23及IL-17水平的影响及意义[J].中国当代儿科杂志,2015,17(8):796-799.
[5]Dillon MJ,Ozen S.A new international classification of children vasculitis[J].Pediatr Nephrol,2006,21(9):1219-1222.
[6]李彩凤.过敏性紫癜[M]//胡亚美,江载芳,申昆玲,等.诸福堂实用儿科学(上册).第8版.北京:人民卫生出版社,2015:773-775.
[7]Kimura S,Takeuchi S,Soma Y,et al.Raised serum levels of interleukins 6 and 8 and antiphospholipid antibodies in an adult patient with Henoch-Sch?nlein purpura[J].Clin Exp Dermatol,2013,38(7):730-736.
[8]Sedaghat Z,Kadkhodaee M,Seifi B,et al.Hind limb preconditioning renoprotection by modulation of inflammatory cytokines after renal ischemia/reperfusion[J].Ren Fail,2016,38(5):655-662.
[9]孙爱玲.过敏性紫癜患儿血清IL-6、IL-8及TNF-α表达的意义[J].中国实用医刊,2011,38(15):26-27.
[10]Ha TS.The role of tumor necrosis factor-alpha in HenochSch?nlein purpura[J].Pediatr Nephrol,2005,20(2):149-153.
[11]Chen T,Guo ZP,Zhang YH,et al.Elevated serum heme oxygenase-1 and insulin-like growth factor-1 levels in patients with Henoch-Sch?nlein purpura[J].Rheumatol Int,2011,31(3):321-326.
[12]李娟,范春燕,吴康.紫癜性肾炎患儿尿中血管紧张素原及丙二醛水平的测定及其临床意义分析研究[J].医学临床研究,2017,34(9):1836-1838.
[13]高岩,邓会英.儿童血液灌流[M]//沈颖,易著文.儿科血液净化技术.北京:清华大学出版社,2012:120-137.
[14]曾萍,洪婕,杨镒宇,等.免疫吸附治疗儿童难治型自身免疫性疾病[J].中华实用儿科临床杂志,2014,29(9):668-671.
[15]Ma DQ,Li Y,Han ZG,et al.Analysis on kidney injury-related clinical risk factors and evaluation on the therapeutic effects of hemoperfusion in children with Henoch-Sch?nlein purpura[J].Eur Rev Med Pharmacol Sci,2017,21(17):3894-3899.
[16]吴小川.儿童过敏性紫癜循证诊治建议解读[J].中华儿科杂志,2013,51(7):508-511.