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  

Clinical effect and mechanism of hemoperfusion in treatment of children with severe abdominal Henoch-Sch?nlein purpura

作　　者：朱颖 董扬 徐达良 江家云 吴琳 柯瑞娟 方韶晗 彭寅 ZHU I~ng;DONG Yang;XU Da-Liang;JIANG Jia-Yun;WU Lin;KE Rui-Juan;FANG Shao-Han;PENG Yin.(Department of Nephrology, Anhui Provincial Children＇s Hospital Hefei 230051, China)

机构地区：[1]安徽省儿童医院肾内科,安徽合肥230051

出　　处：《中国当代儿科杂志》2018年第5期378-382,共5页Chinese Journal of Contemporary Pediatrics

基　　金：安徽省卫生厅临床医学技术应用项目(2008B075)

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 prote

关 键 词：血液灌流 过敏性紫癜 机制 儿童 

分 类 号：R725.5[医药卫生—儿科]