过敏性紫癜治疗进展

Advances in the treatment of allergic purpura (Review)

过敏性紫癜(HSP)是一系统性IgA免疫复合物介导的白细胞破碎性血管炎。临床上主要表现为可触性紫癜、腹痛、关节炎、及肾损害。大多数患者有上呼吸道感染史。90%以上的患者为年龄<10岁的儿童,成人患者较儿童患者表现更复杂的临床特征。大多数HSP患者可以自动缓解,因而支持治疗是主要的治疗措施。口服强的松1-2mg/kg.d维持2周可缓解腹型及关节型患者症状并减少发生慢性肾病的风险性。对于严重肾脏损害的患者建议积极的早期高剂量的激素加免疫抑制剂治疗。HSP肾病预后依赖于肾脏受累的程度,成人患者发生肾功能不全的风险性更高,对这些患者更积极的治疗及之后6月的随访是必要的。

Henoch-Schnlein Purpura（HSP） is a systemic leukocytoclastic vasculitis mediated by IgA and characterized by the clinical features of non-thrombocytopenic palpable purpura,abdominal pain,arthritis and renal involvement.Most patients have an antecedent upper respiratory illness.More than 90 percent of Henoch-Schnlein purpura cases occur in children younger than 10 years,however,adults with this condition are more likely to experience complications than children.Because Henoch-Schnlein purpura spontaneously resolves in most children and adults,supportive treatment is the primary intervention.Oral prednisone at 1 to 2 mg per kg daily for two weeks has been used to treat abdominal and joint symptoms and decrease the odds of developing persistent renal disease.Early aggressive therapy with high-dose steroids plus immunosuppressants is recommended for patients with severe renal involvement.Long-term prognosis depends on the severity of renal involvement.HSP nephritis in adults had a higher risk of progression to renal insufficiency.More aggressive treatment and extended follow-up for at least 6 months were often necessary.