清热消癜汤联合醋酸泼尼松片治疗儿童过敏性紫癜临床观察

Clinical observation of Qingre Xiaodian decoction combined with prednisone acetate tablets in the treatment of henoch-schonlein purpura in children

目的观察清热消癜汤联合醋酸泼尼松片治疗儿童过敏性紫癜(HSP)的临床疗效。方法将110例HSP患儿按照随机数字表法分为2组,均予常规治疗。对照组55例予醋酸泼尼松片治疗;治疗组55例在对照组治疗基础上加清热消癜汤治疗。2组均4周为1个疗程,连续治疗3个疗程。比较2组疗效;观察2组治疗前后凝血功能指标血小板计数(PLT)、纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APPT)变化,2组治疗前后炎症因子白细胞介素6(IL-6)、IL-17、IL-22及转化生长因子β_1(TGF-β_1)变化,2组治疗前后外周血辅助性T细胞17(Th17)、调节性T细胞(Treg细胞)变化;观察2组治疗后临床症状消失时间及皮疹复发次数;观察2组不良反应发生情况。结果治疗组总有效率92. 7%,对照组总有效率80. 0%,治疗组疗效优于对照组(P <0. 05)。2组治疗后PLT、FIB、D-D均较本组治疗前降低(P <0. 05),PT、TT、APTT升高(P <0. 05);且治疗组治疗后PLT、FIB、D-D降低更明显(P <0. 05),PT、TT、APTT升高更明显(P <0. 05)。2组治疗后IL-6、IL-17、IL-22及TGF-β_1均较本组治疗前降低(P <0. 05),且治疗组降低更明显(P <0. 05)。治疗组治疗后Th17较本组治疗前降低(P <0. 05),Treg、Treg/Th17较本组治疗前升高(P <0. 05);治疗组治疗后Th17低于对照组(P <0. 05),Treg、Treg/Th17高于对照组(P <0. 05)。治疗组治疗后皮肤紫癜、腹痛、关节疼痛消失时间均低于对照组(P<0. 05),皮疹复发次数低于对照组(P <0. 05)。不良反应发生率治疗组3. 6%,对照组20. 0%,治疗组不良反应发生情况较对照组轻(P <0. 05)。结论清热消癜汤联合醋酸泼尼松片治疗儿童HSP具有良好的临床疗效,并能有效缓解患儿高凝状态,调节机体的T细胞亚群功能失调,减轻炎症反应。

Objective To observe the clinical effects of Qingre Xiaodian decoction combined with prednisone acetate tablets in the treatment of henoch-schonlein purpura (HSP) in children.Methods 110 children with HSP were divided into two groups according to the random number table method,and all were treated by routine treatment.55 cases in control group were treated by prednisone acetate tablets.55 cases in treatment group were treated by Qingre Xiaodian decoction on the basis of the control group.Both groups were treated for 4 weeks as a course of treatment,and three consecutive courses of treatment.The efficacy of the two groups was compared.The changes of blood coagulation function platelet count (PLT),fibrinogen (FIB) and D-dimer (DD) in the two groups were observed before and after treatment.The changes of inflammatory factors such as interleukin-6 (IL-6),IL-17,IL-22 and transforming growth factor-β1 (TGF-β1) before and after treatment in the two groups were observed before and after treatment.The changes of peripheral blood helper T cells 17 (Th17) and regulatory T cells (Treg cells) in the two groups were observed before and after treatment.The disappearance time and adverse reactions of the two groups were compared.Results The total effective rate was 92.7% in treatment group and 80.00 % in control group.The clinical curative effect of the treatment group was better than that of the control group (P<0.05).After treatment,FIB,PLT and D-D in the two groups were decreased than those in the group before treatment (P<0.05),PT and APTT increased (P<0.05),the decrease of FIB,PLT and DD in the treatment group was more significant (P<0.05 ),PT and APTT in the treatment group increased more significantly (P<0.05).After treatment,the levels of IL-6,IL-17,IL-22 and TGF-β1 in the two groups were lower than those in the group before treatment (P<0.05 ),and the treatment group decreased more significantly (P<0.05).After treatment,Th17 in the treatment group was decreased than that before treatment (P<0.05),Treg and Treg/Th17 were increased than those before treatment (P<0.05).After treatment,Th17 in the treatment group was lower than that in the control group (P<0.05 ),and Treg and Treg/Th17 were higher than that in the control group (P<0.05).After treatment,the disappearance time of skin purpura,abdominal pain and joint pain in the treatment group was shorter than that in the control group (P<0.05),and the recurrence times of skin rash were less than that in the control group (P<0.05).The incidence of adverse reactions was 3.6 % in treatment group and 20.0% in control group.The incidence of adverse reactions in the treatment group was lighter than that in the control group (P<0.05).Conclusion Qingre Xiaodian decoction combined with prednisone acetate tablets has good clinical efficacy in the treatment of children with HSP,and can effectively regulate the body's T cell subset dysfunction,coagulation mechanism and inflammatory response.