血液灌流联合血液透析对重症过敏性紫癜患儿的疗效及其对血清CRP、TNF-α、IL-6和尿NAG、A1b的影响

Effects and changes in serum CRP,TNF-α,IL-6 and urinary NAG,Alb of hemo-perfusion and hemodialysis in children with severe allergic purpura

目的观察血液灌流(HP)联合血液透析(HD)治疗重症过敏性紫癜(HSP)患儿的临床疗效,并探讨其对血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、白蛋白(Alb)水平的影响。方法选取2012年11月—2014年12月于儿科住院治疗重症HSP患儿72例,按随机数字表法分为对照组和观察组,每组36例。2组患儿均给予禁食水、解痉、止血、抗感染以及维持电解质平衡等,对照组采用氢化泼尼松、葡萄糖酸钙、氯雷他定以及低分子肝素钙等常规治疗;观察组在对照组治疗基础上采用HP和HD联合治疗,2组疗程均为2周。观察2组患儿治疗前后临床症状改善情况,分别采用酶联免疫吸附法(ELISA)检测血清CRP、TNF-α、IL-6和免疫比浊法检测尿NAG、Alb变化情况。结果治疗后,观察组患儿在皮疹消退时间,腹痛、关节肿痛缓解时间及血尿、蛋白尿减轻时间均明显短于对照组(P<0.05);2组患儿治疗后血清CRP、TNF-α、IL-6水平与尿NAG和Alb水平较治疗前明显下降(P<0.05),且观察组下降幅度较对照组更为显著(P<0.05);观察组有4例患儿在HD治疗期间出现不同程度的恶心、呕吐及血压轻微降低,均给予对症处理后缓解,治疗期间2组患儿具有良好耐受性。结论 HP联合HD治疗HSP患儿迅速缓解临床症状,减轻炎性反应,降低尿NAG、Alb水平,提高患儿临床疗效。

Objective To observe the blood perfusion flow （HP） combined with hemodialysis （HD） for treatment of children with severe Henoch-Schonlein purpura （ HSP）, and to investigate its effect on the level of serum C-reactive protein （CRP） and tumor necrosis factor alpha （TNF-α）, interleukin-6 （IL-6） and urinary N acetyl beta D amino glucoside enzyme （NAG）, albumin （Alb）. Methods From November 2012 to December 2014, 72 cases of pediatric severe HSP inpatient were enrolled, they were divided into the observation group and the control group according to random number table method, 36 cases in each group. All patients of the two groups were treated with fasting, spasmolysis, hemostasis, anti-infection and maintain electrolyte balance etc. , control group with prednisolone, glucose acid calcium, loratadine, and low molecular weight heparin calcium routine treatment; the observation group on the basis of the treatment in the control group, HP and HD com- bined treatment were used, the courses of treatment in the two groups were 2 weeks. Improvement of the clinical symptoms be- fore and after treatment in two groups of children were observed respectively, enzyme linked immunosorbent assay （EEISA） was used for the detection of serum CRP, TNF-oL, IL-6 and NAG, Alb changes. Results After treatment, the observation group＇s skin rash subsided time, abdominal pain, joint swelling and pain relief time and hematuria, proteinuria reducing time were Significantly shorter than control group （ P 〈 0.05 ） ; after treatment, serum CRP, TNF-α and IL-6 levels and urinary NAG and the levels of Alb were obviously decreased in both of the two groups （ P 〈 0.05） , and the observation group decreased more significantly than that of the control group （ P 〈 0.05 ） ; observation group had 4 cases of children with different degrees of nau- sea, vomiting, andblood pressure during treatment, they were given symptomatic treatment and released, both of the 2 groups of children revealed good tolerance during treatment. Conclusion HP with HD for treatment of HSP can rapidly relieve clinical symptoms, relieve the inflammatory reaction, reduce urinary NAG and Alb levels and improve the clinical efficacy.