血液灌流治疗重症过敏性紫癜的疗效及可能机制

Effect and possible mechanism of hemoperfusion treatment for severe Henoch-Schonlein purpura

目的通过对重症过敏性紫癜（HSP）患儿在接受血液灌流治疗前后临床症状及血清自由基变化的研究，探讨血液灌流治疗重症HSP的疗效及其作用机制。方法收集中南大学湘雅二医院儿科2008年1月至2011年12月住院的23例重症HSP患儿，将其分为传统治疗组13例和血液灌流组10例（传统治疗＋血液灌流）。并同时收集在中南大学湘雅二医院体检的11例健康儿童作为健康对照组。观察并记录治疗前后各组患儿的紫癜、腹痛、关：声痛、血尿、蛋白尿等临床症状及尿红细胞计数、24h尿蛋白定量等临床检验指标。血液灌流组分别在第1次血液灌流前，第1、2、3次血液灌流后收集血清，传统治疗组分别在传统治疗前、治疗后第7大收集血清标本，健康对照组仅收集1次血清。采用分光光度法测定每个血清样本的超氧阴离子（O2-．）、羟自由基（·OH）、过氧化氢（H，0，）、丙二醛（MDA）水平，比较各组组内及组问检测指标。结果2组患儿经治疗后皮疹、腹痛、关节痛、血尿、蛋白尿等临床症状均得到缓解，但血液灌流组患儿症状缓解更快，且尿红细胞计数、24h尿蛋白定量下降更明显。2组HSP患儿血清自由O2-、·OH、H2O2、MDA水平均较对健康对照组明显升高（P均〈0．01）。传统治疗组治疗后，自由基水平下降（P〈0．05）；血液灌流组经过3次灌流后自由基水平逐渐下降，仅第3次灌流后下降有统计学意义（P〈0．05）；与传统组治疗后相比，血液灌流组第3次灌流后自由基水平下降更明显（P〈0．05）。结论1．重症HSP患儿血清白由基明显增多，可能参与了血管炎的发生；2．血液灌流联合传统治疗对重症HSP的近期疗效优于单纯传统治疗；3．血液灌流联合传统治疗较单纯传统治疗更有效地清除重症HSP患儿的血清白由基，减少脂质过氧化物产生，从而减少氧化应激对血管内皮的损害。

Objective To research the changes of clinical symptoms and serum free radical in children with severe Henoch-Sch^nlein purpura （HSP） between before and after accepted hemopeffusion. And evaluate the curative effect of hemopeffusion treatment for severe HSP and discuss the mechanism. Methods Twenty-three severe HSP pa- tients in Children＇s Medical Center of the Second Xiangya Hospital of Central South University which were divided into 2 groups：13 cases were divided into traditional treatment group, l0 cases were divided into hemopeffusion group; ll healthy children were divided into healthy control group. The alleviate situation of clinical symptoms were observed and recorded such as purpura, abdominal pain,joint pain, hematuria, albuminuria, and the changes of urine RBC count,24 hour urine protein quantitative before and after hemopeffusion and traditional treatment. Collected the serum before and after the first time hemopeffusion treatment, after the second time hemopeffusion treatment, after the third time hemoper- fusion treatment in hemopeffusion group;Collected the serum before and after conventional therapy in traditional treat- ment group; Collected only once serum in healthy control group. And then their superoxide anion（ 02-＂ ） , hydroxy radi- cal（ ~ OH） ,hydrogen dioxide（ H202 ） ,malonaldehyde（MDA） values were detected with spectrophotometry. The diffe- rences of each index among each group were compared respectively. Results After treatment, the clinical symptoms of 23 severe HSP children such as rash,abdominal pain,joint pain,hematuria,albuminuria which were reliefed compared to before treatment. The urine erythrocyte count,24 hour urine protein quantitative were reduced in 2 groups, but the symptoms of perfusion group children relieved faster, and the clinical index decreased more obviously. The serum 02. , ~ OH, Hi 02 , MDA levels of 23 HSP children were significantly higher than those of the healthy control group （ all P 〈 0.01 ）. In the traditional treatment group, compared between before and after treatment, the indexes were decreased （ all P 〈 0.05 ） ; After 3 times of hemopeffusion, all indexes were decreased in hemoperfusion group, but only after the third hemoperfusion the indexes were decreased statistically significant（ all P 〈 0.05 ）. But compared with the hemoper- fusion group,the index were decreased more apparently in after the third hemoperfusion,and it was statistically signifi- cant （ P 〈 0.05 ）. Conclusions 1. The serum free radicals are increased in severe HSP children, they may play a role in vasculitis. 2. For severe HSP, the recent therapeutic effect of hemoperfusion ally With traditional treatment is better than the alone traditional treatment. 3. Hemoperfusion ally with traditional treatment can remove more effectly the serum free radicals, reduce lipid peroxide products, then mitigate the damage of the oxidate stress to the vascular endothelial.