不同血液灌流次数与不同甲泼尼龙剂量治疗严重腹型过敏性紫癜的疗效研究
|
摘要
目的:研究不同血液灌流(HP)次数与不同甲泼尼龙剂量治疗重型腹型过敏性紫癜(HSP)患儿的疗效。方法:随机将55例重型腹型HSP患儿分为单用激素治疗组20例、3次HP+激素治疗组17例和单次HP+激素冲击组18例。单用激素治疗组给予甲泼尼龙常规剂量治疗,3次HP+激素治疗组使用血液灌流共3次并给予甲泼尼龙常规剂量治疗,单次HP+激素冲击组给予1次血液灌流联合甲泼尼龙冲击递减疗法。观察并记录三组患儿的皮疹、腹痛、关节痛、呕吐、血便等临床症状的好转时间及住院时间,记录治疗前后三组患儿的血清免疫球蛋白、血清补体及尿微量白蛋白、尿α1微球蛋白变化。结果:单次HP+激素冲击组和3次HP+激素治疗组的皮疹、腹痛、呕吐及血便、关节肿痛消退时间及住院时间比较差异均无统计学意义(P>0.05),但均明显优于单用激素组(P<0.05);治疗后单次HP+激素冲击组和3次HP+激素治疗组的尿微量白蛋白和尿α1微球蛋白和血清Ig E、Ig A水平均明显降低(P<0.05),两组治疗后比较差异无统计学意义(P>0.05),单用激素组治疗前后尿微量白蛋白、尿α1微球蛋白和血清Ig E、Ig A水平比较差异无统计学意义(P>0.05)。三组患儿血清Ig G、Ig M、C3、C4水平治疗前后比较差异无统计学意义(P>0.05)。结论:对于无法完成多次HP的患儿,单次HP联合甲泼尼龙冲击递减疗法治疗重型腹型过敏性紫癜是可供选择的治疗办法。
Objective: To study the efficacy of different times of hemoperfusion(HP) and doses of methylprednisolone in the treatment of children with severe abdominal Henoch-Sch9 nlein purpura(HSP). Methods: Fifty-five children with severe abdominal HSP were randomly divided into single hormone treatment group(n = 20),3-times HP + hormone treatment group(n = 17) and single HP +hormone impaction group(n = 18). Single hormone treatment group was given conventional dose therapy of methylprednisolone; 3-times HP + hormone treatment group received blood perfusion for 3 times and was additionally given conventional dose therapy of methylprednisolone; single HP + hormone impaction group was treated with one hemoperfusion therapy combined with methylprednisolone impaction reduction therapy. The improvement time and hospitalization time of clinical symptoms for rash,abdominal pain,joint pain,vomit,bloody stool and hospitalization time were observed and recorded in 3 groups. Meanwhile, changes of levels of serum immunoglobulin,complement,urinary albumin and urinary α1 microglobulin were measured before and after treatment. Results: There was no significant difference between the single hormone treatment group and 3-times HP +hormone treatment group in disappearance time of rash,abdominal pain,vomit,bloody diarrhea,joint pain and hospitalization time(P>0. 05),yet these two groups were significantly better than the single hormone treatment group(P < 0. 05). After treatment,the urine microalbumin,urine α1 and serum IgE,IgA levels in single HP + hormone impaction group and 3-times HP +hormone treatment group decreased significantly(P < 0. 05),and there was no significant difference between two groups after treatment(P>0. 05). There was no significant difference in urine microalbumin,urine α1 and serum IgE,IgA levels in single hormone treatment group before and after treatment(P>0. 05). There was no significant difference in serum IgG,IgM,C3 and C4 levels among three groups(P > 0. 05). Conclusion: For children who cannot complete multiple HPs,a single HP combined with methylprednisolone impaction therapy for severe abdominal anaphylactoid purpura is an alternative treatment approach.
Objective: To study the efficacy of different times of hemoperfusion(HP) and doses of methylprednisolone in the treatment of children with severe abdominal Henoch-Sch9 nlein purpura(HSP). Methods: Fifty-five children with severe abdominal HSP were randomly divided into single hormone treatment group(n = 20),3-times HP + hormone treatment group(n = 17) and single HP +hormone impaction group(n = 18). Single hormone treatment group was given conventional dose therapy of methylprednisolone; 3-times HP + hormone treatment group received blood perfusion for 3 times and was additionally given conventional dose therapy of methylprednisolone; single HP + hormone impaction group was treated with one hemoperfusion therapy combined with methylprednisolone impaction reduction therapy. The improvement time and hospitalization time of clinical symptoms for rash,abdominal pain,joint pain,vomit,bloody stool and hospitalization time were observed and recorded in 3 groups. Meanwhile, changes of levels of serum immunoglobulin,complement,urinary albumin and urinary α1 microglobulin were measured before and after treatment. Results: There was no significant difference between the single hormone treatment group and 3-times HP +hormone treatment group in disappearance time of rash,abdominal pain,vomit,bloody diarrhea,joint pain and hospitalization time(P>0. 05),yet these two groups were significantly better than the single hormone treatment group(P < 0. 05). After treatment,the urine microalbumin,urine α1 and serum IgE,IgA levels in single HP + hormone impaction group and 3-times HP +hormone treatment group decreased significantly(P < 0. 05),and there was no significant difference between two groups after treatment(P>0. 05). There was no significant difference in urine microalbumin,urine α1 and serum IgE,IgA levels in single hormone treatment group before and after treatment(P>0. 05). There was no significant difference in serum IgG,IgM,C3 and C4 levels among three groups(P > 0. 05). Conclusion: For children who cannot complete multiple HPs,a single HP combined with methylprednisolone impaction therapy for severe abdominal anaphylactoid purpura is an alternative treatment approach.
引文
[1]胡亚美,江载芳,申昆玲,等.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社,2015:773-775.
[2]贾江坤,申权,余淼,等.儿童腹型过敏性紫癜伴严重肠套叠诊疗分析[J].临床急诊杂志,2016,17(4):320-321.
[3]周红霞,梅柏如,赵丽萍,等.血液灌流治疗重症过敏性紫癜17例疗效分析[J].临床儿科杂志,2012,30(4):336-338.
[4]于生友,于力,王丽娜.甲泼尼龙冲击递减疗法治疗重症过敏性紫癜的临床疗效[J].实用儿科临床杂志,2011,26(9):696-698.
[5]杨金露,封其华,武庆斌,等.胃镜下凝血酶喷洒治疗儿童过敏性紫癜合并上消化道出血的临床效果[J].中华实用儿科临床杂志,2014,29(24):1912-1914.
[6]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(1):1625-1628.
[7]谢凯,李秋,王墨,等.小儿过敏性紫癜血液灌流治疗72例分析[J].儿科药学杂志,2011,17(2):7-9.
[8]房夏玲,顾英,贺丽霞,等.过敏性紫癜患儿血液灌流并发症及处理[J].中国妇幼健康研究,2015,26(4):732-734.
[9]刘睿,马路,李长春.儿童紫癜性肾炎临床与病理分析[J].临床儿科杂志,2015,33(6):515-519.
[10]齐海锋,谈小云,傅睿,等.南昌524例过敏性紫癜患儿血清过敏原特异Ig E检测分析[J].江西医药,2016,51(7):619-621.
[11]OZEN S,PISTORIO A,IUSAN S,et al.EULAR/PRINTO/PRES criteria for Henoch-Sch9nlein purpura,childhood polyarteritis nodosa,childhood Wegener granulomatosis and childhood Takayasu arteritis:Ankara 2008.PartⅡ:Final classification criteria[J].Ann Rheum Dis,2010,69(5):798-806.
[12]YUAN P,BO Y,MING G,et al.Apoptosis of human umbilicalvein endothelial cells(HUVEC)induced by Ig A1isolatedfrom Henoch-Sch9nlein purpura children[J].Asian Pac J Allergy Immunol,2014,32(1):34-38.
[13]吴天慧,李志辉,段翠蓉,等.血液灌流对过敏性紫癜患儿免疫功能的影响[J].实用预防医学,2016,23(8):999-1000.
[14]郭妍南,王峥.过敏性紫癜的血液净化治疗[J].实用儿科临床杂志,2012,27(17):1308-1310.
[15]施学文,陈娟,殷铭东,等.糖皮质激素在腹型紫癜中的应用时机及方法探讨[J].临床儿科杂志,2015,33(4):352-353.
[2]贾江坤,申权,余淼,等.儿童腹型过敏性紫癜伴严重肠套叠诊疗分析[J].临床急诊杂志,2016,17(4):320-321.
[3]周红霞,梅柏如,赵丽萍,等.血液灌流治疗重症过敏性紫癜17例疗效分析[J].临床儿科杂志,2012,30(4):336-338.
[4]于生友,于力,王丽娜.甲泼尼龙冲击递减疗法治疗重症过敏性紫癜的临床疗效[J].实用儿科临床杂志,2011,26(9):696-698.
[5]杨金露,封其华,武庆斌,等.胃镜下凝血酶喷洒治疗儿童过敏性紫癜合并上消化道出血的临床效果[J].中华实用儿科临床杂志,2014,29(24):1912-1914.
[6]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(1):1625-1628.
[7]谢凯,李秋,王墨,等.小儿过敏性紫癜血液灌流治疗72例分析[J].儿科药学杂志,2011,17(2):7-9.
[8]房夏玲,顾英,贺丽霞,等.过敏性紫癜患儿血液灌流并发症及处理[J].中国妇幼健康研究,2015,26(4):732-734.
[9]刘睿,马路,李长春.儿童紫癜性肾炎临床与病理分析[J].临床儿科杂志,2015,33(6):515-519.
[10]齐海锋,谈小云,傅睿,等.南昌524例过敏性紫癜患儿血清过敏原特异Ig E检测分析[J].江西医药,2016,51(7):619-621.
[11]OZEN S,PISTORIO A,IUSAN S,et al.EULAR/PRINTO/PRES criteria for Henoch-Sch9nlein purpura,childhood polyarteritis nodosa,childhood Wegener granulomatosis and childhood Takayasu arteritis:Ankara 2008.PartⅡ:Final classification criteria[J].Ann Rheum Dis,2010,69(5):798-806.
[12]YUAN P,BO Y,MING G,et al.Apoptosis of human umbilicalvein endothelial cells(HUVEC)induced by Ig A1isolatedfrom Henoch-Sch9nlein purpura children[J].Asian Pac J Allergy Immunol,2014,32(1):34-38.
[13]吴天慧,李志辉,段翠蓉,等.血液灌流对过敏性紫癜患儿免疫功能的影响[J].实用预防医学,2016,23(8):999-1000.
[14]郭妍南,王峥.过敏性紫癜的血液净化治疗[J].实用儿科临床杂志,2012,27(17):1308-1310.
[15]施学文,陈娟,殷铭东,等.糖皮质激素在腹型紫癜中的应用时机及方法探讨[J].临床儿科杂志,2015,33(4):352-353.