甲泼尼龙冲击递减法对重症HSP患儿的疗效

Clinical effect of pulse decreasing dosage of Methylprednisolone therapy on severe henoch-schonlein purpura in children

目的探讨甲泼尼龙冲击递减疗法治疗重症过敏性紫癜(HSP)患儿的疗效、安全性和对患儿血清炎性因子和血管内皮细胞因子的影响。方法选择2011年7月至2013年6月海宁市人民医院儿科收治的60例重症HSP患儿随机分为治疗1组和治疗2组,在常规治疗和对症处理的基础上,治疗1组采用常规甲泼尼龙治疗,治疗2组采用甲泼尼龙冲击递减疗法;另选择同期健康体检儿童作为对照组。对比观察治疗两组临床治疗效果和血清炎性因子白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-o(TNF-α)、血管内皮细胞因子内皮素-1(ET-1)和一氧化氮(NO)等治疗前后变化和与对照组的比较。结果治疗1组显效率为33.3%,总有效率为73.3%,均显著低于治疗2组的70.0%和93.3%,差异均有统计学意义(x^2值分别为8.076和4.320,均P<0.05);治疗2组住院时间、尿常规恢复正常时间、皮疹消退时间、消化道出血消退时间、腹痛消退时间、关节肿痛消退时间均少于治疗1组,差异均有统计学意义(t值分别为4.685、4.285、2.462、5.099、4.515、5.451,均P<0.05);治疗前,治疗1组和治疗2组IL-6、IL-10和TNF-α均显著高于对照组,差异均有统计学意义(t_1值分别为25.673、19.463、15.309;t_2值分别为22.091、17.556、16.663,均P<0.05);治疗后,治疗1组和治疗2组IL-6、IL-10和TNF-α水平均较治疗前显著降低(t_1值分别为10.086、8.564、9.227;t_2值分别为16.732、12.047、14.336,均P<0.05),且治疗2组均低于治疗1组(t值分别为5.667、5.008、4.461,均P<0.05);治疗前,治疗1组和治疗2组NO和ET-1均显著高于对照组,差异均有统计学意义(t_1值分别为10.004、8.276;t_2值分别为6.786、7.223,均P<0.05);治疗后,治疗1组和治疗2组NO和ET-1水平均较治疗前显著降低t_1值分别为3.278、3.563;t_2值分别为5.225、5.965,均P<0.05),且治疗2组均低于治疗1组(t值分别为3.002、2.874,均P<0.05);两组患儿不良反应发生率比较差异无统计学意义(x^2=1.031,P=0.353)。结论重症过敏性紫癜患儿血管内皮的损害可能参与了血管炎症的发生,甲泼尼龙冲击递减疗法可以改善血管内皮损伤,减轻血管炎症,是一种安全有效的治疗方法 。

Objective To explore the clinical effect and safety of pulse decreasing dosage of Methylprednisolone therapy on severe henoch- schonlein purpura （HSP） in children as well as the influence on inflammatory eytokines and vascular endothelia growth factor. Methods Totally 60 children with severe HSP treated in People＇ s Hospital of Haining City during the period of July 2011 to June 2013 were selected and randomly divided into treatment group 1 and group 2. Based on routine treatment and symptomatic treatment, treatment group 1 was treated with Methylprednisolone therapy and treatment group 2 with decreasing dosage of Methylprednisolone therapy. At the same period 30 health children were chosen as the control group. The clinical curative effect and the changes of inflammatory cytokines intedeukin-6 （ IL- 6）, interleukin 10 （IL-10）, tumor necrosis factor-α （TNF-α） , vascular endothelial cell factor endothelin 1 （ET-1） and nitric oxide （NO） among three groups were observed and compared. Results The excellent rate and total effective rate of treatment group 1 were 33.3% and 73.3% , respectively, which were lower than those in treatment group 2 （70.0% , 93.3% ） with significant difference （χ^2 value was 8. 076 and 4. 320, respectively, both P 〈 0.05 ）. The length of hospitalization stay and the time for clinical symptoms improvement in treatment group 2, including routine urine examination return to normal, deflorescence, regression of gastrointestinal bleeding, disappearance of abdominal pain and regression of articular pain, were significantly shorter than those in treatment group 1 （ t value was 4.685, 4. 285, 2. 462, 5. 099, 4. 515 and 5. 451, respectively, all P 〈0.05）. Before the treatment the levels of IL-6, IL-10 and TNF-ct in treatment groups were significantly higher than those of the control group, and the differences were significant （ t1 value was 25. 673, 19. 463 and 15. 309, respectively,t2 value was 22. 091, 17. 556 and 16. 663, respectively, all P 〈0.05）. After the treatment the levels of IL-6, IL-10 and TNF-α in treatment groups declined compared with those before treatment （ tI value was 10. 086, 8. 564 and 9. 227, respectively,t2 value was 16.732, 12. 047 and 14. 336, respectively, all P 〈 0.05）, and those of treatment group 2 were lower than treatment group 1 （t value was 5. 667, 5. 008 and 4. 461, respectively, all P 〈 0.05）. Before the treatment, the levels of NO and ET-1 in treatment groups were significantly higher than those of the control group, and the difference were significant （ t1 value was 0. 004 and 8. 276, respectively, t2 value was 6. 786 and 7. 223, respectively, all P 〈0.05）. After the treatment, the levels of NO and ET-1 in treatment groups were lower compared with those before the treatment （ t1 value was 3. 278 and 3. 563, respectively, t2 value was 5. 225 and 5. 965, respectively, all P 〈 0.05 ） , and those of treatment group 2 were lower than treatment group 1 （ t value was 3. 002 and 2. 874, respectively, both P 〈 0.05 ）. The difference was not significant in the incidence of adverse reactions between two treatment groups （χ^2 = 1. 031 ,P = 0. 353 ）. Conclusion Endothelial damages of children with severe HSP may be involved in vascular inflammation. Pulse decreasing dosage of Methylprednisolone therapy can improve endothelial damage and reduce blood vessel inflammation, which is a safe and effective therapy.