维生素D对小儿过敏性紫癜的疗效及对免疫机制的影响
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摘要
目的:研究维生素D对小儿过敏性紫癜(HSP)的疗效及对免疫机制的影响。方法:选取2015年6月-2016年12月在四川省隆昌市人民医院门诊及住院的HSP患儿60例作为研究对象,随机分为对照组和观察组,每组30例。对照组行常规治疗(注射用甲泼尼龙琥珀酸钠1 mg·kg~(-1)·d~(-1),qd,ivgtt),观察组在常规治疗基础上辅以维生素D(800 U/d),疗程3个月。比较两组患儿免疫球蛋白(IgA、IgG、IgM)血清水平的变化、临床症状改善情况、住院时间、疾病复发情况和肾脏损害情况。结果:与治疗前相比,对照组和观察组患儿在出院时和出院后3个月的IgA水平均显著降低(P<0.05,P<0.01)。观察组患儿在出院后3个月的IgA水平显著低于对照组(P<0.05)。两组患儿的紫癜消失时间、消化道受累症状消失时间、关节受累症状消失时间和住院时间均无显著性差异(P>0.05)。观察组患儿的疾病复发和肾脏损害的发生率均显著低于对照组(P<0.05)。结论:维生素D可以调节免疫球蛋白平衡,这可能是其治疗HSP的机制之一。
Objective: To study the effects of vitamin D on Hen?ch-Sch?nlein purpura(HSP) in children and its effects on immune mechanism. Methods: Sixty child outpatients and inpatients with HSP who sought medical care in the People's Hospital of Longchang City, Sichuan Province from June 2015 to December 2016 were recruited for the study and were randomly divided into the control group and the observation group, each consisting of 30 patients. The child patients in the control group received conventional treatment(methylprednisolone sodium succinate for injection at a dosage of 1 mg·kg~(-1)·d~(-1), qd, ivgtt), and the child patients in the observation group were supplemented with vitamin D(800 U/d), in addition to the conventional treatment. The length of treatment course was all 3 months. Changes in the serum levels of immunoglobulins(IgA, IgG and IgM), clinical symptom improvement, length of hospitalization, HSP recurrence and renal damage were compared between the 2 groups. Results: As compared with those before treatment, the serum levels of IgA both in the control group and the observation group all decreased significantly at the time of discharge and 3 months after discharge(P<0.05, P<0.01). The IgA level 3 months after discharge for the observation group was significantly lower than that of the control group(P<0.05). There were no significant differences in the elimination time of purpura, gastrointestinal damage and joint damage, as well as hospitalization days, when comparisons were made between the 2 groups(P<0.05). The rates of recurrence and renal damage in the observation group were all significantly lower than those in the control group(P<0.05). Conclusion: Vitamin D could regulate the balance of immunoglobulin, which might be one of the mechanisms involved in the treatment of HSP.
Objective: To study the effects of vitamin D on Hen?ch-Sch?nlein purpura(HSP) in children and its effects on immune mechanism. Methods: Sixty child outpatients and inpatients with HSP who sought medical care in the People's Hospital of Longchang City, Sichuan Province from June 2015 to December 2016 were recruited for the study and were randomly divided into the control group and the observation group, each consisting of 30 patients. The child patients in the control group received conventional treatment(methylprednisolone sodium succinate for injection at a dosage of 1 mg·kg~(-1)·d~(-1), qd, ivgtt), and the child patients in the observation group were supplemented with vitamin D(800 U/d), in addition to the conventional treatment. The length of treatment course was all 3 months. Changes in the serum levels of immunoglobulins(IgA, IgG and IgM), clinical symptom improvement, length of hospitalization, HSP recurrence and renal damage were compared between the 2 groups. Results: As compared with those before treatment, the serum levels of IgA both in the control group and the observation group all decreased significantly at the time of discharge and 3 months after discharge(P<0.05, P<0.01). The IgA level 3 months after discharge for the observation group was significantly lower than that of the control group(P<0.05). There were no significant differences in the elimination time of purpura, gastrointestinal damage and joint damage, as well as hospitalization days, when comparisons were made between the 2 groups(P<0.05). The rates of recurrence and renal damage in the observation group were all significantly lower than those in the control group(P<0.05). Conclusion: Vitamin D could regulate the balance of immunoglobulin, which might be one of the mechanisms involved in the treatment of HSP.
引文
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[10]Zhang J,Zeng H,Wang N,et al.Beneficial effects of creatine phosphate sodium for the treatment of Hen9ch-Sch9nlein purpura in patients with early renal damage detected using urinary kidney injury molecule-1levels[J].Eur J Pediatr,2016,175(1):49-55.
[2]Pacheva I H,Ivanov I S,Stefanova K,et al.Central nervous system involvement in Hen9ch-Sch9nlein purpura in children and adolescents[J].Case Rep Pediatr,2017,2017:5483543.
[3]张远达,董青伟,李荣敏,等.过敏性紫癜患儿25-羟基维生素D3水平变化及意义[J].中国当代儿科杂志,2017,19(3):292-295.ZHANG Yuanda,DONG Qingwei,LI Rongmin,et al.Changes in 25-hydroxyvitamin D3 level in children with Hen9ch-Sch9nlein purpura[J].Chin J Contemp Pediatr,2017,19(3):292-295.In Chinese with English abstract.
[4]Li Y,Zhou Y,Zhu D,et al.The role of T cells in the development of Hen9ch-Sch9nlein purpura[J].Front Biosci(Landmark Ed),2018,23:837-851.
[5]Arslansoyu C,amlar S,Soylu A,Akil6)I,et al.Hen9chSch9nlein purpura,post-streptococcal glomerulonephritis and acute rheumatic carditis after Group Aβ-haemolytic streptococcal infection[J].Paediatr Int Child Health,2018,38(1):73-75.
[6]Pollard S L,Lima J J,Romero K,et al.Associations between serum 25(OH)D concentrations and prevalent asthma among children living in communities with differing levels of urbanization:a cross-sectional study[J].Asthma Res Pract,2017,3(1):5.
[7]Chen O,Zhu X B,Ren P,et al.Henoch Schonlein purpura in children:clinical analysis of 120cases[J].Afr Health Sci,2013,13(1):94-99.
[8]林晓燕,周建锋,晁鹏丽,等.淋巴细胞亚群及免疫球蛋白在儿童过敏性紫癜的意义[J].标记免疫分析与临床,2016,23(10):1172-1176.LIN Xiaoyan,ZHOU Jianfeng,CHAO Pengli,et al.Significance of lymphocyte subgroups and immunoglobulins in children with allergic purpura[J].Label Immunoassays Clin Med,2016,23(10):1172-1176.In Chinese with English abstract.
[9]Pan Y X,Ye Q,Shao W X,et al.Relationship between immune parameters and organ involvement in children with Henoch-Schonlein purpura[J].PLoS One,2014,9(12):e115261.
[10]Zhang J,Zeng H,Wang N,et al.Beneficial effects of creatine phosphate sodium for the treatment of Hen9ch-Sch9nlein purpura in patients with early renal damage detected using urinary kidney injury molecule-1levels[J].Eur J Pediatr,2016,175(1):49-55.