血液净化治疗儿童重症过敏性紫癜的疗效及机制

Efficacy and Mechanism of Action of Hemopurification for Severe Henoch-Schnlein Purpura in Children

目的探讨血液净化治疗儿童重症过敏性紫癜(HSP)的疗效及其可能机制。方法按随机数字表法将80例重症HSP患儿分为对照组和治疗组,每组40例。对照组给予常规治疗(氢化泼尼松、氯雷他定、西咪替丁、葡萄糖酸钙及低分子肝素钙等),疗程为2周;治疗组在常规治疗基础上给予血液灌流(HP)联合血液透析(HD)治疗,每日1次,每次2h,共3次。观察2组患儿治疗前后的临床症状(皮疹、腹痛、消化道出血、血尿、蛋白尿、关节肿痛),并采用双抗体夹心酶联免疫吸附法检测2组患儿治疗前后血清免疫球蛋白A(IgA)、白介素-6(IL-6)、白三烯B4(LTB4)的变化。结果治疗组患儿皮疹消退时间、腹痛/消化道出血缓解时间、关节肿痛缓解时间、血尿/蛋白尿减轻时间均明显低于对照组(P<0.05);2组患儿治疗后血清IgA、IL-6、LTB4水平均明显低于治疗前,且治疗组血清IgA、IL-6、LTB4降低幅度明显大于对照组(P<0.05)。结论血液净化辅助治疗可明显减轻重症HSP患儿的临床症状,其机制可能与血液净化能有效地清除HSP患者体内循环免疫复合物和炎症介质有关。

Objective To investigate the clinical efficacy and mechanism of action of hemopurification for severe Henoch-Schonlein purpura（HSP） in children. Methods Eighty children with severe HSP were randomly divided into two groups,with 40 children in each group. The control group was given conventional treatment （hydroprednisone, loratadine, cimetidine, calcium gluconate and low molecular weight heparin） for 2 weeks. On the basis of conventional treatment, the treatment group was additionally given hemoperfusion and hemodialysis 3 times（once per day, 2 hours per time）. Clinical symptoms （rash, abdominal pain, gastrointestinal bleeding, hematuria, proteinuria and joint swelling and pain） were observed before and after treatment. Serum levels of immunoglobulin A（IgA） ,interleukin 6（I1-6） and leukotriene B4（LTB4） were detected by double antibody sandwich enzyme-linked immunosorbent assay. Results Compared with control group, the time to relief of clinical symptoms was significantly shortened in treatment group（P〈0.05）. The serum levels of IgA,IL-6 and LTB4 significantly decreased after treatment in both groups （P〈0.05） ,and the decrease in treatment group was more obvious than that in control group（P〈0.05）. Conclusion Hemopurification therapy can obviously relieve the clinical symptoms through removing circulating immune complex and inflammatory mediators in children with severe HSP.