血液灌流联合血液透析治疗难治性过敏性紫癜的疗效

Therapeutic Effect of Hemoperfusion Combining with Hemodialysis on Refractory Henoch-Schonlein Purpura in Children

目的观察血液灌流(HP)联合血液透析(HD)治疗难治性过敏性紫癜(HSP)患儿的疗效。方法将2008年4月-2009年2月于本院住院的难治性HSP患儿随机分为治疗组与对照组各20例,均常规予激素、H2受体阻滞剂、钙剂等药物,治疗组加用HP联合HD,连续治疗3d,每次2h,观察期间不良反应,比较2组患儿的消化道症状、皮疹、激素用量、住院时间等临床指标。并应用SPSS11.0软件进行分析。结果 1.治疗组腹痛、血便等消化道症状改善,且起效时间显著优于对照组(P<0.05);2.治疗组皮疹消退较对照组快,差异有统计学意义(P<0.01);3.住院期间治疗组平均激素用量较对照组显著减少(P<0.01);4.治疗组住院时间短于对照组(P<0.05),但治疗组住院总费用高于对照组;5.HP治疗过程中仅见一过性低血压,无出血、电解质紊乱等不良反应;6.随访治疗组患儿1～11个月,17例病情稳定无反复,对照组11例无反复,差异有统计学意义(P<0.05)。结论 HP联合HD治疗儿童难治性HSP有一定疗效,在改善皮肤、消化道症状方面尤为明显,可较快缓解患儿症状,并可缩短住院时间,减少住院期间激素用量。

Objective To observe the curative effect of hemoperfusion combining with hemodialysis on refractory Henoch - schonlein purpura（HSP） in children. Methods Forty children with refractory HSP who admited to children＇s Hospital Affiliated to Soochow University from Apr. 2008 to Feb. 2009 were divided randomly into treatment group and control group （20 children in each group）, all children were cotreated with steroids, H~ receptor antagonist and calcium reagent. In the treatment group,children were also received hemoperfusion combining with hemodialysis for 3 days. The gastrointestinal symptom, purpura, steroid dosage and hospitalized days were compared. SPSS 11.0 soft- ware was used to analyze the data. Results 1. The gastrointestinal symptom such as stomachache and bloody stools in treatment group relieved shortly （P 〈 0.05 ） ;2. Purpura in treatment group disappear quickly than it in control group （P 〈0.01 ） ;3. The average steroid dosage in treatment group was tess than that in control group （P 〈 0. 01 ） ;4. Hospitalized days in treatment group were fewer than that in control group （P 〈 0.05 ）, although the total cost was a little higher; 5. No other severe adverse reaction （ hemorrhage, electrolyte disturbances were seen in the hemoperfusion except some children with temporary hypotension;6. After followed up 1 - 11 months,17 children in treatment group were in stable situation, compared with 11 cases in control group （ P 〈 0.05 ）. Conclusions Hemoperfusion combining with hemodialysis has better effect on refractory HSP in children, especially with relapse of skin and gastrointestinal symptom. It helps to relieve the symptoms quickly, shorten the hospitalized term, and also decrease the total steroid amount. It can be alternative way for the intervention of this prevailence diseases.