静脉注射用人免疫球蛋白联合甲泼尼龙治疗儿童重症过敏性紫癜的临床效果

Clinical effect of intravenous human immunoglobulin combined with methylprednisolone on children with severe anaphylactoid purpura

目的观察静脉注射用人免疫球蛋白(pH4)联合甲泼尼龙治疗儿童重症过敏性紫癜的临床效果。方法选取2010年5月—2020年10月宜宾市第一人民医院收治的重症过敏性紫癜患儿103例,按入院时间先后次序随机分为观察1组(35例),观察2组(34例)和对照组(34例)。在常规治疗基础上,对照组加用地塞米松磷酸钠注射液治疗,观察1组在常规治疗基础上加用注射用甲泼尼龙琥珀酸钠治疗,观察2组则在观察1组基础上加用静脉注射用人免疫球蛋白(pH4)治疗,连续治疗3 d。比较2组治疗后临床相关指标差异,包括临床症状(皮肤紫癜、消化道出血、关节肿痛、腹痛)消退时间、严重紫癜性肾损害发生情况、疗效不佳需接受血液滤过治疗患儿比例、随访1年复发情况等,以及治疗前后细胞免疫学指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))变化。结果观察1组与观察2组各项临床症状消失时间均明显短于对照组(P<0.01),且观察2组短于观察1组(P均<0.01)。观察2组严重紫癜性肾损害发生率、疗效不佳需接受血液滤过治疗患儿比例均低于对照组及观察1组(P均<0.05)。3组患儿复发率比较差异无统计学意义(P>0.05)。细胞免疫学指标中对照组各项指标治疗前后比较差异无统计学意义(P>0.05),观察1组CD4^(+)与CD4^(+)/CD8^(+)比值后较治疗前有明显改善(P均<0.05),观察2组4项细胞免疫学指标均有改善且治疗前后比较差异有统计学意义(P均<0.01);治疗后,观察1组与对照组各项指标组间差异均无统计学意义(P>0.05),观察2组与对照组及观察1组CD3^(+)、CD4^(+)、CD8^(+)水平和CD4^(+)/CD8^(+)比值组间比较差异均有统计学意义(P<0.01)。结论静脉注射用人免疫球蛋白(pH4)联合甲泼尼龙治疗儿童重症过敏性紫癜的临床效果显著提高,可明显减轻患儿痛苦,同时降低严重紫癜性肾损害的发生率及病情进展至需血液滤过的发生率,值得临床推广应用。

Objective To observe the clinical effect of intravenous human immunoglobulin(pH4)combined with methylprednisolone on children with severe anaphylactoid purpura.Methods From May 2010 to October 2020,103 children with severe anaphylactoid purpura were selected from The First People′s Hospital of Yibin.According to the order of admission time,they were randomly divided into observation group 1(35 cases),observation group 2(34 cases)and control group(34 cases).On the basis of routine treatment,the control group was treated with dexamethasone sodium phosphate injection,and the observation group was treated with methylprednisolone sodium succinate injection.While observation group 2 was treated with intravenous human immunoglobulin(pH4)on the basis of observation group 1,continuous treatment for 3 days.The difference of clinical related indexes between the two groups after treatment was compared,including the time of regression of clinical symptoms(skin purpura,gastrointestinal bleeding,joint swelling and pain,abdominal pain),the occurrence of severe purpura renal damage,the proportion of children with poor efficacy who need to receive hemofiltration treatment,the recurrence of follow-up for 1 year,and the changes of cellular immunologic indexes(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before and after treatment.Results The disappearance time of all clinical symptoms in observation group 1 and observation group 2 was significantly shorter than that in control group(P<0.01),and observation group 2 was shorter than observation group 1(P<0.01).The incidence of severe purpura renal damage and the proportion of children requiring hemofiltration treatment in the observation group 2 were lower than those in the control group and the observation group 1(all P<0.05).There was no significant difference in the recurrence rate among the three groups(P>0.05).Among the cellular immunologic indexes,there was no significant difference between the control group before and after treatment(P>0.05).The CD4^(+)and CD4^(+)/CD8^(+)levels of observation group 1 were significantly improved compared with those before treatment(P<0.05).The four cellular immunologic indexes of observation group 2 were improved and the difference was statistically significant before and after treatment(P<0.01).After treatment,there was no significant difference in all indexes between the observation group 1 and the control group(P>0.05).There were significant differences in the levels of CD3^(+),CD4^(+),CD8^(+)and the ratio of CD4^(+)/CD8^(+)between the observation group 2 and the control group and the observation group 1(P<0.01).Conclusion The clinical effect of intravenous human immunoglobulin(pH4)combined with methylprednisolone in the treatment of severe allergic purpura in children was significantly improved.It can significantly reduce the suffering of children,and reduce the incidence of severe purpura renal damage and the incidence of the disease progression to the need of hemofiltration.It is worthy of clinical application.