BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations,but without purpura appearance on the skin,the diagnosis and treatment...BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations,but without purpura appearance on the skin,the diagnosis and treatment are relatively difficult.This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis.CASE SUMMARY A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone.On day 7 after onset,gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash,and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa.On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy,but without complete resolution.On day 19,the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs,by which Henoch-Schonlein purpura was confirmed.After 5 d of sequential treatment with methylprednisolone and prednisone,abdominal pain disappeared and she was discharged.CONCLUSION Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain,and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash.For bacterial infection-induced Henoch-Schonlein purpura,glucocorticoid therapy alone without clearing the infection may not relieve symptoms.展开更多
目的 研究甲泼尼龙冲击递减疗法治疗重型腹型过敏性紫癜( H S P)的临床效果。方法 选择铁岭市中心医院2016年1月-2019年1月收治的小儿重症腹型H SP患儿92例,随机分为观察组和对照组各46例。两组均在常规治疗方案基础上接受激素治疗,对...目的 研究甲泼尼龙冲击递减疗法治疗重型腹型过敏性紫癜( H S P)的临床效果。方法 选择铁岭市中心医院2016年1月-2019年1月收治的小儿重症腹型H SP患儿92例,随机分为观察组和对照组各46例。两组均在常规治疗方案基础上接受激素治疗,对照组采用大剂量甲泼尼龙冲击治疗后口服泼尼松;而观察组采用大剂量甲泼尼龙冲击治疗后递减减量,之后改为口服泼尼松,比较两组患儿的症状、免疫指标改善情况和不良反应发生率。结果 观察组皮疹消退时间、腹痛缓解时间、便潜血转阴时间、关节痛消失时间和肾功能恢复时间均短于对照组,差异均有统计学意义( P<0.05)。两组治疗后IgG呈上升趋势,与治疗前相比差异有统计学意义( P<0.05),而组间差异无统计学意义(P>0.05);IgA、C3、IL-6、IL-8、TNF-α呈下降趋势,与治疗前相比差异有统计学意义(P<0.05),组间差异有统计学意义(P<0.05)。对照组不良反应发生率为8.70%;观察组不良反应发生率为13.04%,差异无统计学意义(P>0.05)。结论 甲泼尼龙冲击递减疗法治疗重型腹型HSP能够快速缓解临床症状和免疫状态,并且未明显增加不良反应,值得临床推广应用。展开更多
基金the Science and Technology Bureau of Sichuan province,No.21ZDYF1329.
文摘BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations,but without purpura appearance on the skin,the diagnosis and treatment are relatively difficult.This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis.CASE SUMMARY A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone.On day 7 after onset,gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash,and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa.On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy,but without complete resolution.On day 19,the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs,by which Henoch-Schonlein purpura was confirmed.After 5 d of sequential treatment with methylprednisolone and prednisone,abdominal pain disappeared and she was discharged.CONCLUSION Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain,and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash.For bacterial infection-induced Henoch-Schonlein purpura,glucocorticoid therapy alone without clearing the infection may not relieve symptoms.
