血液灌流治疗儿童重症过敏性紫癜的疗效观察

发布时间：2018-06-23 12:42

本文选题：血液灌流 + 重症过敏性紫癜　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的过敏性紫癜（Henoch-Sch nlein purpura，HSP）是由免疫复合物介导的系统性血管炎，，以小血管炎为主要病变，属自身免疫性疾病，儿童时期最常见。虽其病程具有自限性，但是在重症患者的急性血管炎症期，如不及时治疗，可出现皮肤皮疹坏死感染、全身血管神经性水肿、关节肿痛使活动受限、剧烈腹痛、消化道出血、肠套叠、肾功能衰竭、DIC等症状，甚至危及生命。药物治疗虽然能抑制炎症介质的生成，但对于重症HSP患儿在“免疫风暴期”产生的大量炎症介质形成的高峰期，药物治疗的效果明显减低，即使“冲击疗法”也不能及时缓解病情，阻止病情继续恶化。血液灌流可以迅速吸附清除血液中的炎症介质，通过“削峰”，使HSP患儿血中炎症介质浓度下降，药物浓度相对增加，增高机体的“药物敏感性”，为后续的药物治疗奠定了基础，从而达到及时控制病情的疗效。本文即通过观察临床HSP患儿的临床表现、血液指标，从而探讨血液灌流治疗儿童重症过敏性紫癜的疗效及应用。方法选取60例符合诊断标准及纳入标准的住院HSP患儿，将其按照患儿家长的知情同意及意愿分为常规组和灌流组，常规组使用常规治疗方案，包括急性期卧床休息，如有细菌或病毒感染，予以抗生素和/或抗病毒药物抗感染治疗，并积极检查出致敏原使HSP患儿避免接触，应用肾上腺糖皮质激素抗炎、H2受体阻滞剂、钙剂、抗凝、改善血管通透性等对症支持治疗，灌流组则在常规治疗的基础上加用血液灌流治疗，观察两组患儿临床症状缓解的情况，并在治疗第二天采取两组患儿清晨空腹肘静脉血液，通过比较两组患儿临床症状缓解的情况及血液指标如IgA、CRP、TNF-α、IL-6的变化，从而分析血液灌流治疗儿童重症过敏性紫癜的临床应用价值。结果 1.常规组治疗前后血液指标IgA、IL-6、TNF-α、CRP的比较均有统计学意义（P0.05），提示常规组药物治疗可能通过抑制IgA、IL-6、TNF-α、CRP等炎症因子的生成，使HSP患儿血液中的浓度下降，从而缓解病情； 2.灌流组治疗前后血液指标IgA、IL-6、TNF-α、CRP的比较均有统计学意义（P0.05），提示血液灌流可能通过吸附作用直接使患儿血液中IgA、IL-6、TNF-α、CRP等炎症因子的浓度下降，从而缓解病情； 3.灌流组患儿血液指标在相同时间段内下降的幅度与常规组患儿比较有统计学意义（p＜0.05），提示血液灌流通过吸附作用较药物治疗更快地使HSP患儿血液中IgA、IL-6、TNF-α、CRP等炎症因子浓度下降，从而快速缓解病情； 4.血液灌流组患儿临床症状缓解的天数与常规组患儿比较有统计学差异（P＜0.05），提示血液灌流可较药物治疗更快地缓解HSP患儿的病情，缩短疗程，缓解患儿的痛苦。结论 1.血液灌流联合药物治疗，不仅能快速吸附清除重症患儿血液中大量的炎症介质，调节机体的免疫紊乱，而且能抑制炎症因子的生成，并保护机体的组织器官避免继续受到损伤，从而快速缓解重症过敏性紫癜患儿的病情，我们推荐作为抢救重症过敏性紫癜患儿，挽救患儿生命的重要手段； 2.血液灌流吸附血液中的炎症介质：IL-6、TNF-α、IgA、CRP，可能是其治疗重症患儿的机理，与药物联用，能相对提高了“药物敏感性”，为后继的药物治疗奠定了基础。 3.血液灌流与血浆置换、免疫吸附比较，更为经济、方便、安全，故我们推荐将血液灌流替代血浆置换，作为抢救重症患儿的方法。
[Abstract]:objective
Henoch-Sch nlein purpura (HSP) is a systemic vasculitis mediated by immune complex. It is the main disease of small vasculitis. It is the most common autoimmune disease. It is the most common in childhood. Although its course is self limiting, the skin rash and necrotic infection may occur in the acute vasculitis of severe patients if not treated in time. Systemic hemo neurotic edema, joint swelling and pain, limited activity, severe abdominal pain, gastrointestinal bleeding, intussusception, renal failure, DIC, and even life endanger. Drug treatment can inhibit the formation of inflammatory mediators, but the peak period for the formation of a large number of inflammatory mediators in severe HSP children during the "immune storm" period, drug treatment The effect is obviously reduced, even if "impact therapy" can not relieve the condition in time and prevent the condition from worsening. Blood perfusion can quickly adsorb the inflammatory mediators in the blood. By "peeling the peak", the concentration of inflammatory mediators in the blood of HSP children is reduced, the concentration of drugs is increased, and the drug sensitivity of the body is increased, as a follow-up drug. In this article, the clinical manifestation and blood indexes of the clinical HSP children were observed and the therapeutic effect and application of hemoperfusion in the treatment of children with severe anaphylactoid purpura were discussed.
Method
60 cases of hospitalized HSP children who met the diagnostic criteria and inclusion criteria were divided into the routine group and the perfusion group according to the informed consent and willingness of the parents. The routine regimen was used in the routine treatment program, including the acute bed rest, such as bacterial or viral infection, antibiotics and / or antiviral drugs for anti infection treatment, and positive examination. Allergens made HSP children avoid contact, applied adrenocorticosteroid anti inflammation, H2 receptor blocker, calcium, anticoagulant, and improved vascular permeability. The perfusion group was treated with hemoperfusion on the basis of routine treatment. The clinical symptoms of two groups of children were observed and two groups of children were taken on the second day of treatment. The clinical application value of hemoperfusion in the treatment of severe anaphylactoid purpura in children was analyzed by comparing the changes of clinical symptoms and blood indexes such as IgA, CRP, TNF- alpha and IL-6 in the two groups of children's elbow vein blood in the morning.
Result
1. the comparison of blood indexes IgA, IL-6, TNF- alpha and CRP before and after treatment in the routine group was statistically significant (P0.05). It suggested that the conventional group drug therapy may reduce the concentration of IgA, IL-6, TNF- a, CRP and other inflammatory factors, thus reducing the concentration of blood in the children of HSP, thus alleviating the disease;
2. the blood indexes of IgA, IL-6, TNF- alpha and CRP before and after treatment were statistically significant (P0.05), suggesting that the blood perfusion may directly reduce the concentration of IgA, IL-6, TNF- a, CRP and other inflammatory factors in the children's blood by adsorption, thus alleviating the condition.
3. the blood indexes of children in the perfusion group were significantly lower than those in the routine group (P < 0.05), suggesting that the blood perfusion was faster to reduce the concentration of IgA, IL-6, TNF-, and CRP in the blood of HSP children by adsorption.
4. the days of relieving the clinical symptoms of children in the hemoperfusion group were significantly different from those in the routine group (P < 0.05), suggesting that the blood perfusion could relieve the patient's condition of HSP faster than the drug treatment, shorten the course of treatment and relieve the pain of the children.
conclusion
1. hemoperfusion combined with drug therapy can not only quickly adsorb and clear a large number of inflammatory mediators in the blood of severe children, regulate the immune disorder of the body, but also inhibit the formation of inflammatory factors and protect the tissues and organs of the body to avoid the continued damage, so as to quickly alleviate the condition of the children with severe allergic purpura. We recommend as a robbing. To rescue children with severe allergic purpura, an important means to save children's life.
2. hemoperfusion to adsorb the inflammatory mediators in blood: IL-6, TNF- alpha, IgA, CRP, may be the mechanism for the treatment of severe children, combined with drugs, which can improve the "drug sensitivity" and lay the foundation for the subsequent drug treatment.
3. hemoperfusion and plasma exchange and immunoadsorption are more economical, convenient and safe. Therefore, we recommend hemoperfusion to replace plasma exchange as a method for rescuing severe children.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.9

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