应用血液灌流与丙种球蛋白治疗儿童过敏性紫癜合并消化道出血单中心对照研究  

Single-center controlled study for application of hemoperfusion and versus gammaglobulin for the treatment of Henoch-Schönlein purpura combined gastrointestinal bleeding in children

作　　者：周鹏[1] 杨星光 赵成广[1] 杜悦[1] 吴玉斌[1] Zhou Peng;Yang Xingguang;Zhao Chengguang;Du Yue;Wu Yubin(Department of Pediatric Nephrology,Rheumatology and Immunology,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Nephrology,Rheumatology and Immunology,Fujian Children′s Hospital,Fuzhou 350014,China)

机构地区：[1]中国医科大学附属盛京医院小儿肾脏风湿免疫科,沈阳110004 [2]福建省儿童医院肾脏风湿免疫科,福州350014

出　　处：《中华实用儿科临床杂志》2024年第3期176-181,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：中国医科大学附属盛京医院临床研究课题(M0072)。

摘　　要：目的对比血液灌流(HP)与丙种球蛋白治疗儿童过敏性紫癜伴消化道出血的临床疗效及安全性。方法病例对照研究。对2015年1月至2019年12月中国医科大学附属盛京医院小儿肾脏风湿免疫科诊断过敏性紫癜及消化道出血的患儿39例进行回顾性分析。根据患儿是否行HP、丙种球蛋白治疗分为HP组和丙种球蛋白组,收集患儿临床资料,并对患儿进行6个月的随访调查,了解有无消化道出血复发及肾脏损伤。应用Fisher′s精确检验、两独立样本t检验、Mann-WhitneyU检验、Kruskal-WallisH检验、方差分析等方法比较组间差异。结果1.HP组20例,丙种球蛋白组19例,丙种球蛋白组年龄小于HP治疗组;2.2组患儿均有明显腹痛及消化道出血,部分患儿伴血管神经性水肿、肉眼血尿等;3.实验室指标比较:2组治疗前炎症指标[白细胞(WBC),C反应蛋白(CRP)]、凝血功能指标[纤维蛋白降解产物(FDP)、D-二聚体(DD)]明显升高,但2组间差异无统计学意义(P>0.05);2组患儿治疗后WBC、CRP、FDP、DD较治疗前下降,但2组间差异无统计学意义(P>0.05);4.临床表现比较:入院3 d内HP组腹痛缓解时间明显短于丙种球蛋白组[1.00(1.00,1.00)d比2.00(1.75,6.50)d,P=0.011];2组消化道出血停止时间差异无统计学意义(P>0.05);5.住院天数比较:3 d内应用HP与4~7 d、≥10 d应用组相比住院天数明显减少[(16.89±4.99)d比(19.20±2.39)d比(34.83±8.40)d,P<0.05],丙种球蛋白组组间及组内比较差异均无统计学意义(均P>0.05);6.住院费用比较:3 d内应用HP与4~7 d、≥10 d应用组相比费用明显减少[25554.03(22168.61,28527.30)元比33619.48(32661.18,36971.47)元比51290.34(34163.04,64772.66)元,P<0.05],应用丙种球蛋白组组间及组内比较差异均无统计学意义(均P>0.05);7.激素用量比较:2组患儿初始激素剂量、丙种球蛋白/HP治疗前剂量、丙种球蛋白/HP治疗后剂量结果差异均无统计学意义(均P>0.05),2种治疗方法安全�Objective To compare the clinical efficacy and safety of hemoperfusion(HP)and gammaglobulin on the treatment of Henoch-Schönlein purpura(HSP)with gastrointestinal bleeding in children.Methods Case-control study.A total of 39 HSP children combined with gastrointestinal bleeding diagnosed in the Department of Pediatric Nephrology,Rheumatology and Immunology,Shengjing Hospital of China Medical University from January 2015 to December 2019 were retrospectively recruited.They were divided into the HP group and the gammaglobulin group according to the therapeutic strategy.Clinical data were collected,and a 6-month follow-up survey was conducted for monitoring the relapse of gastrointestinal bleeding and the occurrence of kidney injury.The differences between groups were compared by Fisher′s exact test,two independent samples t-test,Mann-Whitney U-test,Kruskal-Wallis H-test,and One-Way ANOVA.Results(1)There were 20 cases in the HP group and 19 cases were included in the gammaglobulin group.The gammaglobulin group was younger than the HP treatment group.(2)In addition to gastrointestinal bleeding,children in both groups had other clinical symptoms,such as abdominal pain,angioneurotic edema,and hematuria.(3)Comparison of laboratory indexes:Inflammatory indexes:white blood cell count(WBC),C-creative protein(CRP)and coagulation function indexes:fibrin degradation products(FDP),D-dimer(DD)were significantly elevated before treatment in the 2 groups,and there was no difference between the 2 groups(P>0.05);WBC,CRP and FDP,DD declined in the 2 groups after treatment compared with the former,and there was no difference between the 2 groups(P>0.05);(4)Comparison of clinical manifestations:when HP was applied with gammaglobulin in the treatment window within 3 d,the difference in the time of abdominal pain relief in the HP group was shorter than that of the gammaglobulin group[1.00(1.00,1.00)d vs.2.00(1.75,6.50)d,P=0.011];comparing the time of gastrointestinal bleeding stopping when HP was applied with gammaglobulin comparison,

关 键 词：过敏性紫癜 消化道出血 血液灌流 丙种球蛋白 儿童 

分 类 号：R725[医药卫生—儿科]