儿童急性荨麻疹的临床分析及糖皮质激素应用初探
发布时间：2018-08-23 08:21
【摘要】：荨麻疹是常见的过敏性疾病,皮损主要表现为皮肤粘膜暂时性血管通透性增加而发生的局限性水肿,即为“风团”。荨麻疹是儿童常见的皮肤病,多为急性起病。在儿童急性荨麻疹的患者中,除了皮疹之外,部分患者可出现胃肠道的症状,如腹痛,腹泻,恶心,呕吐,临床上将这一特殊类型的荨麻疹称为腹型荨麻疹。这部分患者往往急性发病,临床表现和症状通常较为严重,但其发病模式和诱因尚未完全明确,又易发生漏诊和误诊,在治疗方面更无规范可依,因此给患儿带来了较大的痛苦。 本研究通过回顾性研究和前瞻性研究分别搜集儿童急性荨麻疹病例,分析儿童急性荨麻疹患者的临床资料,明确儿童急性荨麻疹的诱发因素、临床表现特点,并优化糖皮质激素的临床治疗方案。 回顾性分析研究共入组14岁以下的儿童急性荨麻疹患儿共106例,统计患儿的一般信息,临床症状,实验室检查,糖皮质激素应用方案等。其中男性患儿61例(57.5%),女性患儿45例(42.5%),平均年龄为6.41±3.72岁,平均住院时间为7.02±3.55天。其中伴发腹部症状患者50例,仅表现皮肤症状的患者56例。106例患儿中共有36例患儿发病前有食物、药物、感染、化学物质等诱因。以荨麻疹活动指数(Urticaria Activity Scores, UAS)评分,共76例患儿评为临床表现严重病例。50例伴发腹部症状的患者中,共有48例(45.28%)有腹痛症状,其中重度腹痛8例(7.55%),中度腹痛23例(21.70%),轻度腹痛17例(16.04%)。有22例(20.75%)伴有呕吐,8例(7.55%)伴有腹泻,和4例(3.77%)伴有恶心。有10例患者以腹痛作为首发症状,占所有伴发腹部症状患者20%,腹痛与皮肤症状出现的平均间隔时间为34.08±26.15小时。 106例患儿中,仅13例可单用抗组胺药物控制,余93例均应用糖皮质激素治疗。分析激素用量发现,以强的松用量计算,糖皮质激素平均最高剂量为每天1.64±0.83mg/kg,最高剂量平均应用时间为3.97±1.64天,皮疹平均消失时间为4.77±2.24天,腹痛患者腹痛症状平均消失时间3.30±1.70天。 腹型与非腹型患儿的糖皮质激素使用剂量在统计学上无差异,P0.05；而在减量时间上两组存在明显差异,腹型组糖皮质激素平均最高剂量应用时间(4.48±1.76天)明显长于非腹型组(3.51±1.39天),腹型组患儿减量晚于非腹型组,P0.05。 前瞻性研究的部分共入组14岁以下的儿童急性荨麻疹患儿共241例,其中男性患儿146例(60.6%),女性患儿95例(39.4%),依据临床表现分为腹型组和非腹型组,腹型70例,非腹型171例。分析两组儿童发病诱因、临床表现。并在第一部分调查的基础上,根据病情在腹型组患儿中应用糖皮质激素,剂量以强的松当量lmg/kg/d,若12小时症状不缓解,加量至强的松当量1.6mg/kg/d。观察小剂量糖皮质激素是否可控制腹型荨麻疹症状,并比较低剂量组患儿和高剂量组患儿的激素应用时间、皮疹消失时间和腹痛消失时间。分别比较激素应用剂量和时间与年龄、临床表现之间的关系,优化儿童急性腹型荨麻疹糖皮质激素治疗方案。 241例患儿中,首发病例有193例,再发病例48例,再发病例的首次发病平均年龄为3.19±2.10岁。就诊前平均病程5.23天。共有113例患儿发病前曾有不同类型的感染,其中腹型组39例(55.7%),非腹型组74例(43.3%),并以呼吸道感染最为常见。两组患儿在感染诱因中存在统计学差异,腹型组患儿发疹前感染率明显高于非腹型组。药物是儿童发病的第二大诱因,共有42名患儿发病前有用药史,以抗生素类药物最多见,其次为非甾体类抗炎药。 以UAS评分评价严重程度,70例腹型患儿中临床表现严重者为48人(68.6%),中度者20人(28.6%),轻度者2人(2.86%)。以皮疹为首发症状的占64.3%(45例),以腹痛为首发症状的占14.3%(10例),两者同时发生的占21.4%(15例)。重度腹痛9人(12.9%),中度腹痛22人(31.4%),轻度腹痛38人(54.3%)。非腹型组中临床表现严重组54人(31.6%),中度组79人(46.2%),轻度组38人(22.2%)。腹型患儿在风团数量及瘙痒程度上明显重于非腹型患儿,两组数据有统计学差异(P0.05)。 治疗方面,腹型组70例患儿中,仅13例可单用抗组胺药物控制,余57例均有应用糖皮质激素。但是非腹型组则大部分(142例)可用抗组胺药物控制。腹型57例应用激素的患儿中,35例(61.4%)应用低剂量激素治疗(强的松当量1mg/kg/d)即可控制,另有22例(38.6%)患儿需应用高剂量激素治疗(强的松当量1.6mg/kg/d)。结果显示：两组患儿在皮疹评分及腹痛评分上无差异,在应用不同剂量激素后症状均可缓解,且平均最高剂量应用时间,皮疹消失时间,腹痛消失时间均无统计学差异,P0.05。 通过以上研究发现,感染、药物是儿童急性荨麻疹的主要发病诱因。部分患儿以腹痛为首发症状,导致误诊或漏诊；儿童急性腹型荨麻疹患儿应用抗组胺药物控制不佳的情况下,应及早应用糖皮质激素治疗。大部分患儿小剂量激素应用(1mg/kg/d)即可控制,无需大剂量应用。临床观察12小时,若症状不缓解,糖皮质激素剂量可加量至强的松当量1.6mg/kg/d。
[Abstract]:Urticaria is a common allergic disease. The main manifestation of the skin lesion is a temporary increase in vascular permeability of the skin and mucosa and the occurrence of localized edema, that is, the "mass of wind." Urticaria is a common skin disease in children, mostly acute onset. In children with acute urticaria, in addition to rash, some patients may have gastrointestinal symptoms. Such as abdominal pain, diarrhea, nausea, vomiting, clinical will this special type of urticaria called abdominal urticaria. This part of patients often acute onset, clinical manifestations and symptoms are usually more serious, but its mode of onset and incentives are not yet fully clear, but also prone to missed diagnosis and misdiagnosis, in the treatment of more non-standard, so bring to the children Greater pain.
In this study, retrospective and prospective studies were conducted to collect children with acute urticaria, analyze the clinical data of children with acute urticaria, identify the predisposing factors, clinical features, and optimize the clinical treatment of glucocorticoid.
A total of 106 children under 14 years old with acute urticaria were analyzed retrospectively. The general information, clinical symptoms, laboratory examinations, and glucocorticoid regimens of the children were analyzed. Among them, 61 were male (57.5%) and 45 were female (42.5%) with an average age of 6.41 (+ 3.72) and an average length of stay of 7.02 (+ 3.55 days). A total of 36 out of 56 children with abdominal symptoms were predisposed to food, drugs, infections, chemicals, etc. A total of 76 children with severe clinical symptoms were assessed by Urticaria Activity Scores (UAS) score. There were 48 cases (45.28%) with abdominal pain, including 8 cases (7.55%) with severe abdominal pain, 23 cases (21.70%) with moderate abdominal pain, 17 cases (16.04%) with mild abdominal pain. 22 cases (20.75%) with vomiting, 8 cases (7.55%) with diarrhea, and 4 cases (3.77%) with nausea. The average time interval is 34.08 + 26.15 hours.
Of 106 children, only 13 were controlled by antihistamines alone, and the remaining 93 were treated with glucocorticoids. According to the analysis of the dosage of glucocorticoids, the average maximum dose of glucocorticoids was 1.64 (+ 0.83 mg/kg) per day, the average duration of the maximum dose was 3.97 (+ 1.64) days, the average disappearance time of rash was 4.77 (+ 2.24) days, and the abdominal pain was observed. The average time of abdominal pain disappeared was 3.30 + 1.70 days.
There was no statistical difference in the dosage of glucocorticoids between abdominal and non-abdominal type children (P 0.05), but there was significant difference in the reduction time between the two groups. The average maximum dosage of glucocorticoids in abdominal type group (4.48 +1.76 days) was significantly longer than that in non-abdominal type group (3.51 +1.39 days), and the reduction of glucocorticoids in abdominal type group was later than that in non-abdominal type group (P 0.05).
The prospective study included 241 children under 14 years old with acute urticaria, including 146 males (60.6%) and 95 females (39.4%). They were divided into abdominal group and non-abdominal group according to their clinical manifestations, 70 abdominal type and 171 non-abdominal type. Glucocorticoid was used in the abdominal group according to the condition. The dosage was prednisone equivalent lmg/kg/d. If the symptoms did not ease in 12 hours, the dosage was 1.6 mg/kg/d. To observe whether small doses of glucocorticoid could control the symptoms of abdominal urticaria, and to compare the time of hormone application between the low dosage group and the high dosage group, the rash disappeared. To optimize the therapeutic regimen of glucocorticoid in children with acute abdominal urticaria, the relationship between dosage and time of hormone administration and age, clinical manifestations were compared.
Of the 241 children, 193 had the first onset, 48 had the second onset, and the average age of the first onset was 3.19 (+ 2.10) years. The average course of disease was 5.23 days before admission. The incidence of pre-eruption infection in abdominal group was significantly higher than that in non-abdominal group. Drugs were the second most common predisposing factor, and 42 children had a history of pre-eruption drug use, most of which were antibiotics, followed by non-steroidal anti-inflammatory drugs.
According to the UAS score, 48 (68.6%) of 70 children with abdominal type had severe clinical manifestations, 20 (28.6%) were moderate, and 2 (2.86%) were mild. 64.3% (45 cases) had rash as the first symptom, 14.3% (10 cases) had abdominal pain as the first symptom, and 21.4% (15 cases) had severe abdominal pain, 9 (12.9%) had moderate abdominal pain and 22 (31.3%) had moderate abdominal pain. There were 54 cases (31.6%) with severe clinical manifestations in the non-abdominal group, 79 cases (46.2%) in the moderate group and 38 cases (22.2%) in the mild group.
In the abdominal group, only 13 cases were controlled by antihistamines alone, and the rest 57 cases were controlled by glucocorticoids. However, most of the non-abdominal group (142 cases) could be controlled by antihistamines. The results showed that there was no difference in skin rash score and abdominal pain score between the two groups. Symptoms were relieved after different doses of hormone, and the mean maximum dose of hormone application time, rash disappearance time and abdominal pain disappearance time had no statistical difference (P 0.05).
Through the above study, we found that infection, drugs are the main cause of acute urticaria in children. Some children with abdominal pain as the first symptom, leading to misdiagnosis or missed diagnosis; children with acute abdominal urticaria in children with poor control of antihistamines, should be treated as early as possible with glucocorticoids. Most children with small doses of hormones (1) The dosage of glucocorticoid can be increased to 1.6 mg/kg/d if the symptoms do not ease after 12 hours of clinical observation.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R758.24
本文编号：2198470
[Abstract]:Urticaria is a common allergic disease. The main manifestation of the skin lesion is a temporary increase in vascular permeability of the skin and mucosa and the occurrence of localized edema, that is, the "mass of wind." Urticaria is a common skin disease in children, mostly acute onset. In children with acute urticaria, in addition to rash, some patients may have gastrointestinal symptoms. Such as abdominal pain, diarrhea, nausea, vomiting, clinical will this special type of urticaria called abdominal urticaria. This part of patients often acute onset, clinical manifestations and symptoms are usually more serious, but its mode of onset and incentives are not yet fully clear, but also prone to missed diagnosis and misdiagnosis, in the treatment of more non-standard, so bring to the children Greater pain.
In this study, retrospective and prospective studies were conducted to collect children with acute urticaria, analyze the clinical data of children with acute urticaria, identify the predisposing factors, clinical features, and optimize the clinical treatment of glucocorticoid.
A total of 106 children under 14 years old with acute urticaria were analyzed retrospectively. The general information, clinical symptoms, laboratory examinations, and glucocorticoid regimens of the children were analyzed. Among them, 61 were male (57.5%) and 45 were female (42.5%) with an average age of 6.41 (+ 3.72) and an average length of stay of 7.02 (+ 3.55 days). A total of 36 out of 56 children with abdominal symptoms were predisposed to food, drugs, infections, chemicals, etc. A total of 76 children with severe clinical symptoms were assessed by Urticaria Activity Scores (UAS) score. There were 48 cases (45.28%) with abdominal pain, including 8 cases (7.55%) with severe abdominal pain, 23 cases (21.70%) with moderate abdominal pain, 17 cases (16.04%) with mild abdominal pain. 22 cases (20.75%) with vomiting, 8 cases (7.55%) with diarrhea, and 4 cases (3.77%) with nausea. The average time interval is 34.08 + 26.15 hours.
Of 106 children, only 13 were controlled by antihistamines alone, and the remaining 93 were treated with glucocorticoids. According to the analysis of the dosage of glucocorticoids, the average maximum dose of glucocorticoids was 1.64 (+ 0.83 mg/kg) per day, the average duration of the maximum dose was 3.97 (+ 1.64) days, the average disappearance time of rash was 4.77 (+ 2.24) days, and the abdominal pain was observed. The average time of abdominal pain disappeared was 3.30 + 1.70 days.
There was no statistical difference in the dosage of glucocorticoids between abdominal and non-abdominal type children (P 0.05), but there was significant difference in the reduction time between the two groups. The average maximum dosage of glucocorticoids in abdominal type group (4.48 +1.76 days) was significantly longer than that in non-abdominal type group (3.51 +1.39 days), and the reduction of glucocorticoids in abdominal type group was later than that in non-abdominal type group (P 0.05).
The prospective study included 241 children under 14 years old with acute urticaria, including 146 males (60.6%) and 95 females (39.4%). They were divided into abdominal group and non-abdominal group according to their clinical manifestations, 70 abdominal type and 171 non-abdominal type. Glucocorticoid was used in the abdominal group according to the condition. The dosage was prednisone equivalent lmg/kg/d. If the symptoms did not ease in 12 hours, the dosage was 1.6 mg/kg/d. To observe whether small doses of glucocorticoid could control the symptoms of abdominal urticaria, and to compare the time of hormone application between the low dosage group and the high dosage group, the rash disappeared. To optimize the therapeutic regimen of glucocorticoid in children with acute abdominal urticaria, the relationship between dosage and time of hormone administration and age, clinical manifestations were compared.
Of the 241 children, 193 had the first onset, 48 had the second onset, and the average age of the first onset was 3.19 (+ 2.10) years. The average course of disease was 5.23 days before admission. The incidence of pre-eruption infection in abdominal group was significantly higher than that in non-abdominal group. Drugs were the second most common predisposing factor, and 42 children had a history of pre-eruption drug use, most of which were antibiotics, followed by non-steroidal anti-inflammatory drugs.
According to the UAS score, 48 (68.6%) of 70 children with abdominal type had severe clinical manifestations, 20 (28.6%) were moderate, and 2 (2.86%) were mild. 64.3% (45 cases) had rash as the first symptom, 14.3% (10 cases) had abdominal pain as the first symptom, and 21.4% (15 cases) had severe abdominal pain, 9 (12.9%) had moderate abdominal pain and 22 (31.3%) had moderate abdominal pain. There were 54 cases (31.6%) with severe clinical manifestations in the non-abdominal group, 79 cases (46.2%) in the moderate group and 38 cases (22.2%) in the mild group.
In the abdominal group, only 13 cases were controlled by antihistamines alone, and the rest 57 cases were controlled by glucocorticoids. However, most of the non-abdominal group (142 cases) could be controlled by antihistamines. The results showed that there was no difference in skin rash score and abdominal pain score between the two groups. Symptoms were relieved after different doses of hormone, and the mean maximum dose of hormone application time, rash disappearance time and abdominal pain disappearance time had no statistical difference (P 0.05).
Through the above study, we found that infection, drugs are the main cause of acute urticaria in children. Some children with abdominal pain as the first symptom, leading to misdiagnosis or missed diagnosis; children with acute abdominal urticaria in children with poor control of antihistamines, should be treated as early as possible with glucocorticoids. Most children with small doses of hormones (1) The dosage of glucocorticoid can be increased to 1.6 mg/kg/d if the symptoms do not ease after 12 hours of clinical observation.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R758.24
【参考文献】
相关期刊论文 前2条
1 谢广清;张胜;龙晓玲;阮健;梁展图;付四毛;;儿童腹型荨麻疹5例胃镜特征和临床分析[J];广东医学;2010年23期
2 陈明春;黄樱樱;邹勇男;;慢性荨麻疹与乙型肝炎病毒感染的关系[J];中国热带医学;2009年09期
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