不同方案治疗儿童过敏性紫癜1010例的队列研究

Cohort study on 1010 children with Henoch-Schonlein purpura receiving different treatment programs

目的探讨中西医结合阶梯治疗方案预防过敏性紫癜(HSP)早期肾损伤的疗效,为临床诊治提供参考。方法收集2014年1月至2015年1月的HSP患儿1010例,分为方案一731例,方案二279例,采用不同方案阶梯治疗,通过队列研究比较不同治疗、腹痛程度、临床分型时肾损伤率。结果(1)方案一、方案二治疗后肾损伤率分别为13.82%(101/731)、18.64%(52/279),两者比较差异无统计学意义(P>0.05);方案一治疗后轻+中度肾损率为90.1%(91/101),高于方案二76.9%(40/52),差异有统计学意义(P<0.05),方案一肾损伤程度较轻;方案一肾脏受累时间(52.48±31.44)d,方案二为(40.39±27.18)d,差异有统计学意义(P<0.05)。(2)1010例HSP患儿伴腹痛462例,3个月内出现肾损伤87例(18.83%),中、重型腹痛出现肾损伤率高于轻型,差异有统计学意义(P<0.05);腹型肾损率19.61%(41/209)、混合型18.18%(46/253)高于皮肤型11.16%(24/215),差异有统计学意义(P<0.05)。结论(1)两种方案均能降低HSP肾损伤率,中西医结合阶梯治疗预防肾损伤有效。(2)腹型和混合型HSP患儿更易发生肾损伤,腹痛程度越重,肾损伤率越高。

Objective To investigate the effect of the ladder treatment with traditional Chinese and western medicine in the prevention of early renal injury of Henoch-Schonlein purpura(HSP).Methods A total of 1010 children with HSP from January 2014 to January 2015 were collected,and were divided into program 1(731 cases)and program 2(279 cases).Different programs were adopted for the ladder treatment.By cohort study,renal injury rates were compared in treatment,abdominal pain,and clinical typing.Results(1)The rate of renal damage after treatment was 13.82%(101/731)and 18.64%(52/279)for program 1 and program 2,respectively,and there was no statistical difference between the two programs(P>0.05).The rate of mild+moderate renal damage was 90.1%(91/101)for program 1,which was higher than that for program 2(76.9%,40/52)(P<0.05);the degree of renal damage for program 1 was lower.The duration of renal involvement in program 1 was(52.48±31.44)d,and it was(40.39±27.18)d in program 2,the difference being statistically significant(P<0.05).(2)In the 1010 HSP children,462 had abdominal pain,87(18.83%)had renal damage within 3 months,and the rate of renal damage in the children with,moderate and severe abdominal pain was higher than in those with mild pain,and there was statistical difference(P<0.05).The rate of renal damage was 19.61%(41/209)in the abdominal type and 18.18%(46/253)in the mixed type,which was higher than that in the skin type(11.16%,24/215),the difference being statistical(P<0.05).Conclusion(1)Both of the two kinds of programs can reduce the rate of renal damage in HSP,and the combination ladder treatment of traditional Chinese medicine with western medicine is effective in the prevention of renal damage.(2)Renal damage is more likely to occur in children with abdominal-type and mixed-type HSP,and the more severe the abdominal pain,the higher the rate of renal damage.