摘要
目的 观察血液灌流（HP）联合血液透析（HD）对重症过敏性紫癜（HSP）的临床疗效,并从炎症因子的角度探讨HP联合HD治疗重症HSP的机制.方法 选择2008年7月至2009年5月本院肾脏科重症HSP患儿104例,按随机数字表法分为HP＋HD组（50例）和常规治疗组（54例）.HP＋HD组采用HP联合HD治疗,常规治疗组采用激素联合抗过敏及低分子肝素钙治疗,两组均治疗2周.观察两组患儿治疗后相关临床症状改善情况;用酶联免疫吸附法（ELISA）检测治疗前后患儿血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）浓度;用免疫散射比浊法测定尿微量蛋白（Albu）及N-乙酰-β-D-氨基葡萄糖苷酶（NAG）的变化.结果 HP＋HD组皮疹消退、腹痛和四肢疼痛减轻、血便减少等临床症状改善时间较常规治疗组明显缩短（均P〈0.05）;HP＋HD组治疗后患儿血清IL-6、TNF-α、CRP浓度及尿Albu、NAG均较治疗前显著降低,且降低幅度较常规治疗组更明显（均P〈0.01）;HP＋HD组IL-6、TNF-α、CRP、Albu、NAG变异系数（CV%）分别为30.12%、21.30%、18.70%、27.61%、27.81%,常规治疗组分别为80.79%、81.86%、63.86%、80.65%、88.51%.结论 HP联合HD可能是通过清除血液中的炎症介质来缓解临床症状、减轻肾脏病理损伤.
Objective To investigate the clinical therapeutic effect of hemoperfusion （HP） combined with hemodialysis （HD） for treatment of patients with severe allergic purpura, and from standpoint of inflammatory factors to approach the mechanism of the treatment. Methods One hundred and four children with severe allergic purpura from July 2008 to May 2009 in Nephrology Department of Jiangxi Children Hospital were enrolled, and randomly divided into HP combined with HD group （50 eases） and conventional therapy group （54 cases）. HP-^-HD group was treated with HP combined with HD for 6 hours. Routine therapy was applied to the conventional therapy group for 2 weeks, such as glucocorticoid, cimetidine, calcium gluconate and low molecular weight hepaearin. The related symptoms, serum concentrations of interleukin-6 （ IL-6 ）, tumor necrosis factor-α （TNF-α）, C-reactive protein （CRP） detected by enzyme linked immunosorbent assay （ELISA） as well as microalbuminuria （Albu） and N-αcetyl-β-D-glucosaminidase （NAG） in urine examined by immune scattering turbidimetry were observed. Results The improvement times of severe allergic purpura related symptoms including regression of rash, mitigation of abdominal pain and pain of limbs, reduction of bloody stool in HP＋HD group were shorter than those of conventional therapy group （all P〈0.05）. The serum concentrations of IL-6, TNF-α, CRP and the levels of Albu and NAG in urine were reduced significantly in HP＋HD group, and the reducing effect was more evident in HP-β-HD group than that in conventional therapy group （all P〈0. 01）. The variation coefficients （CV%） of IL-6, TNF-α, CRP, urine Albu and NAG in the HP＋HD group were 30.12%, 21.30%, 18.70%, 27.61%, 27.81%, respectively, while in the conventional therapy group, they were 80.79%, 81.86%, 63.86%, 80. 65%, 88.51%, respectively. Conclusion Eliminating blood inflammatory mediators may be a possible way for HP combined with HD to alleviate clinical symptoms and kindey pathological injuries.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2010年第6期349-351,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
基金项目：江西省医药卫生普通计划项目（20081132）
关键词
过敏性紫癜
重症
血液灌流
血液透析
炎症因子
Severe allergic purpura
Hemoperfusion
Hemodialysis
Inflammatory mediator
