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目的探讨甲泼尼龙冲击递减疗法治疗小儿重症过敏性紫癜(HSP)的临床疗效。方法 2005年6月-2010年6月本院儿科收治的HSP患儿78例,选择其中58例重症HSP患儿为观察对象。采用双盲法随机分为治疗组及对照组。治疗组32例。男19例,女13例;年龄3~13岁。对照组26例。男17例,女9例;年龄3~14岁。治疗组32例患儿采用甲泼尼龙冲击递减疗法;对照组26例患儿采用常规甲泼尼龙冲击治疗;病情明显改善后改用相同剂量的泼尼松口服逐渐减量至停用。观察皮疹消退、腹痛缓解、消化道出血及关节肿痛缓解时间,观察肾脏损害恢复时间及皮肤紫癜复发情况。各组检查血常规、尿常规和大便常规;检测肝肾功能、免疫球蛋白和补体(C3、C4);检测其血清IL-6、IL-8及TNF-α水平变化。结果治疗组皮疹消退、腹痛缓解、消化道出血消退、关节肿痛消退及肾损害恢复时间明显短于对照组(P<0.05,0.01)。治疗组及对照组治疗后免疫球蛋白、补体和细胞因子IL-6、IL-8及TNF-α与治疗前比较差异均有统计学意义(Pa<0.05)。结论甲泼尼龙冲击递减疗法治疗小儿重症HSP安全有效,是防止复发和减轻肾脏损害较好的治疗措施。
Objective To investigate the clinical efficacy of methylprednisolone impact-decrement therapy in the treatment of severe allergic purpura (HSP) in children. Methods From June 2005 to June 2010, 78 children with HSP were admitted to our hospital, and 58 children with severe HSP were selected as the observation subjects. Double-blind method were randomly divided into treatment group and control group. Treatment group of 32 cases. 19 males and 13 females; aged 3 to 13 years. Control group of 26 cases. 17 males and 9 females; aged 3 to 14 years. Thirty-two children in the treatment group were treated with methylprednisolone impact reduction therapy. Twenty-six children in the control group were treated with conventional methylprednisolone. The patients were treated with the same dose of prednisone and then tapered. Observed rash subsided, abdominal pain relief, digestive tract bleeding and joint pain relief time to observe the recovery time of kidney damage and skin purpura recurrence. The blood routine, urinary routine and stool routine were examined in each group. The liver and kidney function, immunoglobulin and complement (C3 and C4) were detected. The levels of IL-6, IL-8 and TNF-α were detected. Results The treatment group had subsided rash, relieved abdominal pain, subsided gastrointestinal bleeding, subsidence of joint pain and recovery of renal damage significantly shorter than that of the control group (P <0.05, 0.01). After treatment, the immunoglobulin, complement and cytokines IL-6, IL-8 and TNF-α in the treatment group and the control group were significantly different from those before treatment (Pa <0.05). CONCLUSION: Methylprednisolone impact-descending therapy is safe and effective in the treatment of severe HSP in children and is a good treatment to prevent relapse and reduce renal damage.