单次剂量环磷酰胺静脉冲击与静脉丙种球蛋白冲击治疗儿童重型腹型过敏性紫癜疗效比较  

Comparison of therapeutic effects between single-dose CTX intravenous pulse therapy and IVIG pulse therapy for severe gastrointestinal involvement of Henoch Schönlein purpura in children

作　　者：胡雅兰 王婷[1] 付强[1] HU Yalan;WANG Ting;FU Qiang(Department of Pediatrics,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou 434020,China)

机构地区：[1]长江大学附属荆州医院儿科,湖北荆州434020

出　　处：《实用医学杂志》2023年第22期2974-2978,共5页The Journal of Practical Medicine

基　　金：湖北省卫生计生委科研项目(编号:WJ2018H210);湖北省儿科联盟科学基金项目(编号:HBPASF-2019-06)。

摘　　要：目的观察单次剂量环磷酰胺(CTX)静脉冲击治疗重型腹型过敏性紫癜的疗效及安全性。方法回顾分析256例过敏性紫癜腹部受累患儿临床特征及诊疗情况,根据疼痛数字评价量表(NRS-11)、临床特征分为普通型组(157例)与重型组(99例),根据静脉丙种球蛋白(IVIG)与CTX应用与否将重型组分为IVIG组(53例)与CTX组(46例)。选择同期入院体检50例儿童为健康对照组。观察各组实验室指标变化,分析药物疗效、病情反复情况、并发症及不良反应等。结果与普通型组比较,重型组WBC、NE及CRP均明显升高(P<0.05);HGB、ALB及IgG均明显降低(P<0.05);RDW、PLT、Cr、CystatinC、IgA及补体C3、C4差异无统计学意义(P>0.05)。CTX组与IVIG组患儿比较,治疗前各实验室指标均差异无统计学意义(P>0.05),但腹痛缓解时间、血便消失时间、禁食时间及静脉甲泼尼龙使用时间及平均住院日明显缩短(P<0.05);甲泼尼龙累计用量、腹痛及皮疹复发明显减少(P<0.05);血尿和(或)蛋白尿例数比较,差异无统计学意义(P>0.05);未发生出血性膀胱炎、白细胞减少或严重胃肠道反应。结论当腹型过敏性紫癜患儿处于高炎症状态及低IgG水平,且较高剂量糖皮质激素撤减困难时,尽早使用CTX静脉治疗,单次剂量可较快控制疾病活动,降低血便及腹痛复发率,减少糖皮质糖素用量,且无明显不良反应,其疗效优于IVIG。Objective The study aimed to explore the efficacy and safety of single-dose CTX intravenous pulse therapy for severe gastrointestinal involvement of Henoch Schönlein purpura in children.Methods A total of 256 children with abdominal Henoch-Schönlein purpura admitted to the Department of Pediatrics of Jingzhou Hospital affiliated to Yangtze University from January 1 in 2017 to June 1 in 2022 were divided into three groups according to the pain digital evaluation scale(NRS-11)and clinical characteristics,which were common type group(157 cases)and severe type group(99 cases).According to the different treatment options of IVIG and CTX,the severe group was divided into IVIG group(53 cases)and CTX group(46 cases).50 healthy children admitted to the hospital for physical examination during the same period were selected as the control group.The changes of laboratory indicators were compared in each group,and the drug efficacy,repeated conditions,complications and adverse reactions were analyzed.Results There was no difference in all laboratory indicators between the healthy control group and the common type group(P>0.05).Compared with common type group,WBC,NE and CRP were significantly higher in severe group(P<0.05);HGB,ALB and IgG were significantly decreased(P<0.05);there was no difference in RDW,PLT,Cr,CystatinC,IgA,C3 and C4(P>0.05).Meanwhile,there was no difference in laboratory indicators between the CTX group and the IVIG group before treatment.Resolution of abdominal pain,hemafecia,time of fasting,duration of intravenous methylprednisolone and the average hospitalization were significantly shortened(P<0.05);cumulative use of methylprednisolone,recurrence of abdominal pain and new rashes were significantly reduced(P<0.05).In addition,there were no obvious adverse reactions in CTX group,such as hemorrhagic cystitis,leukopenia or severe gastrointestinal reactions.Conclusion When the child is in a high inflammatory state and low IgG level,and it is difficult to withdraw the high dose of glucocorticoid,the early us

关 键 词：腹型过敏性紫癜 重症 环磷酰胺 糖皮质激素 静脉丙种球蛋白 儿童 

分 类 号：R725[医药卫生—儿科]