血液灌流治疗儿童重症腹型过敏性紫癜的临床疗效和机制探讨

Clinical effect and mechanism of hemoperfusion in treatment of children with severe abdominal Henoch-Schönlein purpura

摘要:

目的 观察血液灌流（HP）治疗儿童重症腹型过敏性紫癜（HSP）的疗效并初步探讨其机制。方法 24例重症腹型HSP患儿分为常规治疗组（12例）和血液灌流组（12例），并以10例健康体检儿童作为对照组。采用化学发光法检测对照组以及两个治疗组治疗前后的血清白介素-6（IL-6）、肿瘤坏死因子α（TNF-α）水平，以及硫代巴比妥酸比色法检测血浆丙二醛（MDA）水平，羟胺法检测血浆超氧化物歧化酶（SOD）水平，化学比色法检测血浆总抗氧化能力（T-AOC）。结果 与健康组比，常规组及HP组治疗前的IL-6、TNF-α、MDA明显增多，SOD、T-AOC明显下降（P < 0.05），但常规组及HP组之间的差异无统计学意义（P > 0.05）；与治疗前比较，治疗后常规组及HP组患儿的IL-6、TNF-α、MDA水平均下降，SOD、T-AOC均回升，差异均有统计学意义（P < 0.05），而且HP组变化较常规组更显著，但与健康组相比差异仍有统计学意义（P < 0.05）。与HP组比较，治疗后第4天常规组消化道症状控制的比例较低，皮疹和消化道症状控制所用的时间较长，差异有统计学意义（P < 0.05）；与常规组比较，HP组激素用量较小，病程6个月内发生血尿和/或蛋白尿的几率小，差异均有统计学意义（P < 0.05）；两组在住院时间以及病程6个月以内的皮疹、腹痛复发率的差异无统计学意义（P > 0.05）。结论 HP可以降低重症腹型HSP患儿激素用量、肾损伤发生几率，机制可能与HP有效清除IL-6、TNF-α、MDA有关。

Abstract:

Objective To study the clinical effect and mechanism of hemoperfusion (HP) in the treatment of children with severe abdominal Henoch-Schönlein purpura (HSP). Methods A total of 24 children with severe abdominal HSP were divided into two groups:conventional treatment and HP (n=12 each). Ten healthy children who underwent physical examination were enrolled as the control group. Before and after treatment, chemiluminescence was used to measure the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α); thiobarbituric acid colorimetry was used to measure the plasma level of malondialdehyde (MDA); the hydroxylamine method was used to measure the plasma level of superoxide dismutase (SOD); chemical colorimetry was used to measure the plasma level of total anti-oxidant capability (T-AOC). Results Compared with the control group, the conventional treatment and HP groups had significantly higher IL-6, TNF-α, and MDA levels and significantly lower SOD and T-AOC levels before treatment (P < 0.05), but there were no significant differences between the conventional treatment and HP groups (P > 0.05). After treatment, the conventional treatment and HP groups had significant reductions in IL-6, TNF-α, and MDA levels and significant increases in SOD and T-AOC levels (P < 0.05). The HP group had significantly greater changes than the conventional treatment group; however, there were still significant differences in these indices between the HP and control groups (P < 0.05). Compared with the HP group, the conventional treatment group had a significantly lower percentage of children with disappearance of digestive tract symptoms at 4 days after treatment and significantly longer time to disappearance of rash and digestive tract symptoms (P < 0.05). Compared with the conventional treatment group, the HP group had a significantly lower amount of glucocorticoid used during treatment and a significantly lower percentage of children who experienced hematuria and/or proteinuria within 6 months of the disease course (P < 0.05). There were no significant differences between the two groups in length of hospital stay and recurrence rates of rash and abdominal pain within 6 months of the disease course. Conclusions HP can reduce the amount of glucocorticoid used during treatment and the incidence rate of kidney injury in children with severe abdominal HSP, possibly by eliminating IL-6, TNF-α, and MDA.