發(fā)布時間：2018-06-23 12:42

  本文選題：血液灌流 + 重癥過敏性紫癜�。� 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：目的 過敏性紫癜（Henoch-Sch nlein purpura，HSP）是由免疫復合物介導的系統(tǒng)性血管炎，，以小血管炎為主要病變，屬自身免疫性疾病，兒童時期最常見。雖其病程具有自限性，但是在重癥患者的急性血管炎癥期，如不及時治療，可出現(xiàn)皮膚皮疹壞死感染、全身血管神經(jīng)性水腫、關節(jié)腫痛使活動受限、劇烈腹痛、消化道出血、腸套疊、腎功能衰竭、DIC等癥狀，甚至危及生命。藥物治療雖然能抑制炎癥介質(zhì)的生成，但對于重癥HSP患兒在“免疫風暴期”產(chǎn)生的大量炎癥介質(zhì)形成的高峰期，藥物治療的效果明顯減低，即使“沖擊療法”也不能及時緩解病情，阻止病情繼續(xù)惡化。血液灌流可以迅速吸附清除血液中的炎癥介質(zhì)，通過“削峰”，使HSP患兒血中炎癥介質(zhì)濃度下降，藥物濃度相對增加，增高機體的“藥物敏感性”，為后續(xù)的藥物治療奠定了基礎，從而達到及時控制病情的療效。本文即通過觀察臨床HSP患兒的臨床表現(xiàn)、血液指標，從而探討血液灌流治療兒童重癥過敏性紫癜的療效及應用。 方法 選取60例符合診斷標準及納入標準的住院HSP患兒，將其按照患兒家長的知情同意及意愿分為常規(guī)組和灌流組，常規(guī)組使用常規(guī)治療方案，包括急性期臥床休息，如有細菌或病毒感染，予以抗生素和/或抗病毒藥物抗感染治療，并積極檢查出致敏原使HSP患兒避免接觸，應用腎上腺糖皮質(zhì)激素抗炎、H2受體阻滯劑、鈣劑、抗凝、改善血管通透性等對癥支持治療，灌流組則在常規(guī)治療的基礎上加用血液灌流治療，觀察兩組患兒臨床癥狀緩解的情況，并在治療第二天采取兩組患兒清晨空腹肘靜脈血液，通過比較兩組患兒臨床癥狀緩解的情況及血液指標如IgA、CRP、TNF-α、IL-6的變化，從而分析血液灌流治療兒童重癥過敏性紫癜的臨床應用價值。 結果 1.常規(guī)組治療前后血液指標IgA、IL-6、TNF-α、CRP的比較均有統(tǒng)計學意義（P0.05），提示常規(guī)組藥物治療可能通過抑制IgA、IL-6、TNF-α、CRP等炎癥因子的生成，使HSP患兒血液中的濃度下降，從而緩解病情； 2.灌流組治療前后血液指標IgA、IL-6、TNF-α、CRP的比較均有統(tǒng)計學意義（P0.05），提示血液灌流可能通過吸附作用直接使患兒血液中IgA、IL-6、TNF-α、CRP等炎癥因子的濃度下降，從而緩解病情； 3.灌流組患兒血液指標在相同時間段內(nèi)下降的幅度與常規(guī)組患兒比較有統(tǒng)計學意義（p＜0.05），提示血液灌流通過吸附作用較藥物治療更快地使HSP患兒血液中IgA、IL-6、TNF-α、CRP等炎癥因子濃度下降，從而快速緩解病情； 4.血液灌流組患兒臨床癥狀緩解的天數(shù)與常規(guī)組患兒比較有統(tǒng)計學差異（P＜0.05），提示血液灌流可較藥物治療更快地緩解HSP患兒的病情，縮短療程，緩解患兒的痛苦。 結論 1.血液灌流聯(lián)合藥物治療，不僅能快速吸附清除重癥患兒血液中大量的炎癥介質(zhì)，調(diào)節(jié)機體的免疫紊亂，而且能抑制炎癥因子的生成，并保護機體的組織器官避免繼續(xù)受到損傷，從而快速緩解重癥過敏性紫癜患兒的病情，我們推薦作為搶救重癥過敏性紫癜患兒，挽救患兒生命的重要手段； 2.血液灌流吸附血液中的炎癥介質(zhì)：IL-6、TNF-α、IgA、CRP，可能是其治療重癥患兒的機理，與藥物聯(lián)用，能相對提高了“藥物敏感性”，為后繼的藥物治療奠定了基礎。 3.血液灌流與血漿置換、免疫吸附比較，更為經(jīng)濟、方便、安全，故我們推薦將血液灌流替代血漿置換，作為搶救重癥患兒的方法。
[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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R725.9

【參考文獻】

相關期刊論文 前10條

1 徐立軍;;過敏性紫癜的中樞神經(jīng)系統(tǒng)損害[J];中國當代兒科雜志;2007年03期

2 王瓊瑾;張融;;感染在兒童過敏性紫癜中的作用[J];當代醫(yī)學;2010年25期

3 謝凱;李秋;王墨;唐雪梅;王曉剛;;小兒過敏性紫癜血液灌流治療72例分析[J];兒科藥學雜志;2011年02期

4 溫建艷;季偉鋒;張德忠;;HSP患兒血清IL-6、TNF-α和CRP水平的變化[J];放射免疫學雜志;2009年03期

5 張交生;宋麗君;;過敏性紫癜病因及發(fā)病機制的最新研究進展[J];國際兒科學雜志;2006年04期

6 楊惠泉;黃玉柱;程炳蓉;蔣惠云;黃建華;;血液灌流治療兒童重癥過敏性紫癜一例[J];中外醫(yī)療;2010年06期

7 劉禮樂;以腹痛為首發(fā)癥狀的過敏性紫癜臨床特點及誤診原因[J];臨床誤診誤治;2004年10期

8 金莉;楊忠浩;沈群華;馮建華;;過敏性紫癜患者血清中TNF-α、NO、IL-2和IL-6水平的觀察[J];現(xiàn)代實用醫(yī)學;2009年03期

9 陳寧寧;閆京京;王玫瑰;于艷輝;劉健勝;白華;江蕓;盧思廣;;常見吸入、食物性過敏原與兒童過敏性紫癜體液免疫的相關研究[J];黑龍江醫(yī)藥科學;2012年05期

10 高興華;陳楠;;血管炎的發(fā)病機制[J];皮膚病與性病;2008年01期

本文編號：2057159