血液灌流治疗过敏性紫癜严重病例的疗效及其可能机制

发布时间：2018-06-17 09:29

本文选题：过敏性紫癜 + 紫癜性肾炎　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：观察过敏性紫癜严重病例血液灌流治疗前后的临床症状及血清中胰岛素样生长因子-1、白介素-17含量的变化，探讨血液灌流治疗过敏性紫癜严重病例的疗效及其可能机制。方法：收集2012年5月至2014年1月泸州医学院附属医院儿科住院的40例过敏性紫癜严重病例，并分为2组：A组、B组，每组各20例。A组仅采取传统治疗（包括抗炎、抗凝、抗过敏等对症治疗）；B组采取血液灌流联合传统治疗。同时收集我院门诊体检中心的15例健康儿童作为正常对照组（C组）。观察并记录A、B两组患儿治疗前后的腹痛、血便、皮疹、关节肿痛、血管神经性水肿的变化，以及尿微量白蛋白、尿红细胞计数的检查结果，并统计住院时间。A组在治疗前、后采集静脉全血3ml；B组在血液灌流治疗前、第一次、第二次、第三次血液灌流结束时采集静脉全血3ml；C组仅体检时采集一次静脉全血3ml。将上诉标本进行离心，取上清液，采用酶联免疫吸附试验（ELISA）测定每例标本中的胰岛素样生长因子-1、白介素-17的含量，分别比较治疗前后各项检测指标及临床症状在各组间、组内的差异，并对比A、B两组的住院时间。结果：40例过敏性紫癜严重病例在治疗后腹痛、血便、皮疹、关节肿痛、血管神经性水肿均得到缓解，以B组缓解更快，且住院时间缩短；但反映肾脏受累的尿微量白蛋白、尿红细胞计数在A、B两组治疗前后的差异无统计学意义。治疗前A、B两组血清中的胰岛素样生长因子-1、白介素-17含量均显著高于正常对照组， A、B两组组间差异无统计学意义；治疗后A、B组患儿上述细胞因子的含量均较治疗前明显下降，，差异有统计学意义（P 0.01）；而B组在第三次血液灌流结束后的下降较A组更显著，差异有统计学意义(P 0.01)；A、B两组在治疗后各细胞因子仍高于C组,差异有统计学意义(P 0.01)；B组患儿在三次血液灌流后上述细胞因子较治疗前均有下降趋势，但第一次血液灌流后的下降无统计学意义（P0.05）；第二次、第三次灌流后的下降均有统计学意义（P0.05）；各细胞因子在三次血液灌流结束后的进行两两比较，仅第一次与第二次的比较无统计学意义(P0.05)。伴有肾脏受累（尿微量白蛋白及尿红细胞计数阳性）的患儿,胰岛素样生长因子-1、白介素-17的含量均较不伴肾脏受累的明显升高，差异有统计学意义（P 0.01）。上诉指标进行相关性分析提示胰岛素样生长因子-1、白介素-17之间存在正相关关系，有统计学意义(p0.05)；尿微量白蛋白与胰岛素样生长因子-1、白介素-17的含量呈正相关关系,有统计学意义(p0.05)；尿红细胞计数与胰岛素样生长因子-1、白介素-17含量呈相关关系，但均无统计学意义（P0.05）。结论：1.过敏性紫癜严重病例血清胰岛素样生长因子-1、白介素-17的含量较正常儿童均明显升高，上述细胞因子可能参与了过敏性紫癜血管炎症反应的发生发展；2.血液灌流联合传统治疗对于过敏性紫癜严重病例的近期疗效明显优于单纯传统治疗；3.血液灌流联合传统治疗在清除过敏性紫癜严重病例血液中的炎症介质胰岛素样生长因子-1、白介素-17，平衡免疫功能方面优于单纯传统治疗；4.肾脏受累的过敏性紫癜患儿血清中胰岛素样生长因子-1、白介素-17的含量均较不伴肾脏受累者高；5.血液灌流联合传统治疗及单纯传统治疗，在近期均未能显示出肾脏保护作用。血液灌流联合传统治疗能否改善紫癜性肾炎的预后，仍需进一步的研究及远期随访。
[Abstract]:Objective: To observe the clinical symptoms, the changes of serum insulin like growth factor -1 (IGF) and the content of il--17 in serum before and after hemoperfusion in severe cases of anaphylactoid purpura, and to explore the effect and possible mechanism of hemoperfusion in the treatment of allergic purpura severe cases. Methods: from May 2012 to January 2014, the children of Affiliated Hospital of Luzhou Medical College were collected. 40 cases of anaphylactoid purpura severe cases in the hospital were divided into 2 groups: group A and group B, 20 cases in each group of.A were treated with traditional treatment (including anti-inflammatory, anticoagulant, antiallergic and other symptomatic treatment); group B was treated with blood perfusion combined with traditional treatment. At the same time, 15 healthy children in the medical center of our hospital were collected as the normal control group (group C). A, B two groups of children with abdominal pain, blood stool, rash, joint swelling and pain, changes in vascular neurodropsy, urine microalbumin, urine red blood cell count examination results, and the time of hospitalization time.A group before the treatment, after the collection of venous blood 3ml; group B before the blood perfusion treatment, the first, second, third blood perfusion ends. The total venous blood 3ml was collected and the C group collected only one vein whole blood 3ml. to centrifuge the appellate specimen and take the supernatant, and use the enzyme linked immunosorbent assay (ELISA) to determine the insulin like growth factor -1 and the content of interleukin -17 in each sample. A, B two groups of hospitalization time. Results: 40 cases of anaphylactoid purpura severe cases of abdominal pain after treatment, blood stool, rash, joint swelling and pain, vascular neuroedema were alleviated, B group remission faster, and hospitalization time shorter; but reflect the kidney involvement of urine microalbumin, urine red blood cell count in the A, B two groups before and after treatment The serum levels of IGF -1 and interleukin -17 in the serum of A and B two before treatment were significantly higher than those in the normal control group, and there was no significant difference between the two groups of A and B. The contents of the cytokines in the A and B group were significantly lower than those before the treatment (P 0.01), while the B group was in the B group. After the third blood perfusion, the decrease was more significant than that in the A group (P 0.01); A, B two groups were still higher than the C group after treatment (P 0.01). The above cytokines in the B group were decreased after three blood perfusion, but the decrease after the first blood perfusion was no longer than before the treatment. Statistical significance (P0.05); second and third times after perfusion were statistically significant (P0.05); each cell factor was compared at the end of the three hemoperfusion, and there was no significant difference between the first and second times (P0.05). The content of ISL like growth factor -1 and interleukin -17 was significantly higher than that of renal involvement, the difference was statistically significant (P 0.01). The correlation analysis of the appeal indicators suggested that there was a positive correlation between insulin like growth factor -1, interleukin -17, and statistically significant (P0.05); urine microalbumin and insulin like growth factor -1 The content of interleukin -17 was positively correlated (P0.05), and the urine red cell count was related to the content of insulin like growth factor -1 and interleukin -17, but there was no statistical significance (P0.05). Conclusion: 1. the serum insulin like growth factor -1 and the content of interleukin -17 in the severe cases of Henoch Schonlein purpura and the content of interleukin -17 are more obvious than those of normal children. The above cytokines may be involved in the development of anaphylactoid purpura vascular inflammation, 2. hemoperfusion combined with traditional treatment is obviously better than traditional treatment for the severe cases of anaphylactoid purpura; 3. hemoperfusion combined with traditional treatment in the removal of inflammatory mediators in the blood of allergic purpura severe cases ISL like growth factor -1, il--17, balanced immune function is superior to simple traditional treatment; 4. the serum levels of IGF -1 and il--17 in children with Henoch Schonlein purpura with renal involvement are higher than those without renal involvement; 5. the combination of traditional and traditional treatment of hemoperfusion can not be shown in the near future. Renal protection. Whether hemoperfusion combined with traditional treatment can improve the prognosis of Henoch Schonlein purpura nephritis still needs further study and long-term follow-up.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.5

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