血液灌流治疗儿童重症过敏性紫癜的现状调查  

Current situation of hemoperfusion in the treatment of children with severe Henoch-Schonlein purpura

作　　者：中国医师协会儿科医师分会血液净化专家委员会 董扬 徐达良 朱颖 雷晔飞[3] 曲强 冯仕品 谢敏 刘喜 王墨[5] 万俊丽[5] 焦佳[5] 石咏琪 杨琴[5] 高岩 李颖杰 许自川 李宇红 蒋新辉 邵晓珊 陶仲宾[8] 李宇宁[8] 闫小莉 夏正坤[9] 何旭[9] 史聿 赵非[10] 王文琰 刘雪梅 张洪霞 潘艳艳 赵丽君[12] 仇三玲 陈朝英[13] 耿海云[13] 栾江威[14] 祝高红[14] 威畅 赵丽萍 诸澎伟 包瑛[16] 黄惠梅[16] 张晨美[17] 朱履昌[17] 赵成广[18] 杨星光 吴玉斌[18] 党西强[19] 李晓燕[19] Pediatric Blood Purification Specialist Committee of Pediatric Association in Chinese Medical Doctor Association

机构地区：[1]不详 [2]安徽省儿童医院,合肥230051 [3]郴州市第一人民医院,423000 [4]成都市妇女儿童中心医院,610091 [5]重庆医科大学附属儿童医院,400014 [6]广州市妇女儿童医疗中心,510120 [7]贵阳市儿童医院,550003 [8]兰州大学第一医院,730000 [9]南京军区南京总医院,210002 [10]南京医科大学附属儿童医院,210008 [11]山东大学齐鲁儿童医院,济南250022 [12]山西省儿童医院,太原030013 [13]首都儿科研究所附属儿童医院,北京100020 [14]武汉儿童医院,430016 [15]无锡儿童医院,214023 [16]西安市儿童医院,710003 [17]浙江大学医学院附属儿童医院,杭州310003 [18]中国医科大学附属盛京医院,沈阳110004 [19]中南大学湘雅二医院,长沙410011

出　　处：《中国小儿急救医学》2018年第6期429-433,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的了解我国行血液灌流治疗重症过敏性紫癜患儿的临床表现和实验室指标特点，为制定血液灌流治疗重症过敏性紫癜患儿共识提供依据。方法以中国医师协会儿科医师分会血液净化专家委员会的部分成员单位共18家医院为调查中心，专家委员会部分专家参与制定《重症过敏性紫癜登记表》，对其近3年住院的588例行血液灌流的重症过敏性紫癜患儿病例资料进行回顾性分析。结果重症过敏性紫癜患儿临床表现上除皮疹外，以腹痛、消化道出血或关节肿痛为主，其他临床表现包括血管神经性水肿、肉眼血尿、高血压和意识障碍。除少数患儿外，大部分患儿行2～3次血液灌流后临床症状有明显缓解。实验室指标包括血白细胞、血小板、D-二聚体、纤维蛋白原和肌酐较灌流前有明显下降趋势，差异有统计学意义（P〈0.05），C反应蛋白及24 h尿蛋白定量较灌流前有下降趋势，但差异无统计学意义（P〉0.05）。灌流期间不良反应较少发生，以低血压为主。97.96%的患儿以治愈作为出院结局。结论对于重症过敏性紫癜，临床症状以腹痛为主，可伴有消化道出血、血尿蛋白尿、关节痛，或严重病例药物治疗无效者，应及时行血液灌流。ObjectiveTo study the clinical manifestations and laboratory characteristics of hemoperfusion in the treatment of children with severe Henoch-Schonlein purpura（HSP） in our country, and provide the basis for the establishment of the consensus of hemoperfusion treatment for the children with severe HSP.MethodsA total of 18 hospitals of members of the Pediatric Blood Purification Specialist Committee of Pediatric Association in Chinese Medical Doctor Association were selected as the survey centers.Some experts of the Committee participated in the formulation of ＂The Registration Form for Severe HSP＂ . Totally the data of 588 cases of children with severe HSP were collected by survey centers in the last 3 years for a retrospective analysis.ResultsThe main clinical manifestations of children with severe HSP were abdominal pain, gastrointestinal bleeding or joint swelling and pain except for skin rash, other symptoms included neurovascular edema, gross hematuria, hypertension and disturbance of consciousness.Except a few children, most were relieved by hemoperfusion treatment after 2-3 times.The laboratory indexes including blood leukocyte, platelets, D-Dimer, fibrinogen and creatinine significantly decreased after hemoperfusion, and there were statistical significances（P〈0.05）. C-reactive protein and 24 hour urine protein had a downward trend com-pared with that before hemoperfusion, but there was no statistical significance （P〉0.05）. During hemoperfusion, adverse reactions that mainly were hypotension occurred lessly.Cure was the discharge result of 97.96% of children with severe HSP.ConclusionFor severe HSP, when the clinical symptoms are mainly abdominal pain accompanied with gastrointestinal bleeding, hematuria, proteinuria, arthralgia, or severe cases which can′t be cured by general treatment, we should use hemoperfusion in time.

关 键 词：过敏性紫癜 血液灌流 儿童 现状 

分 类 号：R725.546[医药卫生—儿科]