糖皮质激素在腹型紫癜中的应用时机及方法探讨  

Treatment timing and method of glucocorticoids in abdominal type Henoch-Schnlein purpura

作　　者：施学文 陈娟 殷铭东 陈向前 曹青 

机构地区：[1]江苏省泗洪儿童医院，江苏 泗洪 223900

出　　处：《临床儿科杂志》2015年第4期352-356,共5页Journal of Clinical Pediatrics

摘　　要：目的：探讨糖皮质激素在腹型过敏性紫癜（HSP）中的应用时机及方法。方法2009年9月至2013年4月住院治疗的腹型HSP患儿201例，根据接受激素治疗时间及方法不同分为4组：早期常规组46例，晚期常规组44例，早期滴注组56例，晚期滴定组55例。均使用相同的基础治疗，分别采用激素常规及快速滴定治疗。消化道症状出现至使用激素时间≤3 d为早期治疗，〉3 d为晚期治疗。早期和晚期常规组甲基泼尼松龙剂量为2～6 mg/（kg·d），早期和晚期滴定组甲基泼尼松龙从小剂量开始快速滴定至靶剂量，初始剂量2 mg/（kg·d）。每12小时对消化道症状进行评估，如消化道症状不缓解，则追加上一次剂量，次日以前一日24 h总剂量作为初始剂量，以此类推直至患儿消化道症状完全缓解，并以此剂量连续应用3 d后开始减量、维持至停用，如出现消化道症状反复则使用前一日维持剂量3 d后再减量至停用。观察期3～6个月，统计分析4组患儿的用药剂量、复发情况及不良反应。结果4组消化道症状完全缓解时间、激素使用靶剂量、激素使用总量、消化道症状反复和严重消化道症状出现的发生率以及HSP肾炎发生率的差异均有统计学意义（P〈0.05）；其中早期滴定组的疗效最佳，而晚期常规组的效果最差。结论腹型HSP以消化道症状完全缓解为目标进行早期糖皮质激素滴定治疗可取得良好效果，并可减少激素用量。ObjectivesTo study the treatment timing and method of glucocorticoids in the treatment of abdominal type Henoch-Schnlein purpura （HSP）.MethodsA total of 201 children with abdominal type HSP hospitalized from September 2009 to April 2013 received either conventional glucocorticoids treatment or rapid titration treatment of glucocorticoids based on the same basic therapy. According to the treatment timing and method of glucocorticoids, all patients were divided into 4 groups including early convention group （n=46）, late convention group （n=44）, early titration group （n=56） and late titration group （n=55）. The duration from the appearance of gastrointestinal symptoms to using glucocorticoids less than or equal to three days was deifned as early treatment and more than three days was deifned as late treatment. The patients in two convention groups （early and late） were treated with methylprednisolone （2-6mg/kg per day）.The patients in two titration groups （early and late） received rapid titration of methylprednisolone from an initial low dose of 2mg/kg per day to the ifnal target dose. The gastrointestinal symptoms were evaluated every 12 hours. If the gastrointestinal symptoms were not alleviated, an additional dosage of methyl-prednisolone was given. On the next day, the total dose of methylprednisolone in previous 24 hours was used as the initial dose. The dosage was increased in such a way till the gastrointestinal symptoms disappeared and this dosage was remained for 3 days. Then the dosage was gradually reduced to the maintenance dose and stopped. If the gastrointestinal symptoms were relapsed, the patients were treated again. A follow-up of 3-6 months was performed. The dosage, recurrence of symptoms and the side effects were compared among four groups.ResultsThe time of remission, target dose of glucocorticoids, total dose of glucocorticoids, recurrence rate, incidence of severe symptoms and Henoch-Schonlein purpura nephritis were signiifcantly different among four groups （P�

关 键 词：过敏性紫癜 糖皮质激素 治疗 

分 类 号：R725.5[医药卫生—儿科]