兒童急性蕁麻疹的臨床分析及糖皮質(zhì)激素應(yīng)用初探
發(fā)布時(shí)間：2018-08-23 08:21
【摘要】：蕁麻疹是常見(jiàn)的過(guò)敏性疾病,皮損主要表現(xiàn)為皮膚粘膜暫時(shí)性血管通透性增加而發(fā)生的局限性水腫,即為“風(fēng)團(tuán)”。蕁麻疹是兒童常見(jiàn)的皮膚病,多為急性起病。在兒童急性蕁麻疹的患者中,除了皮疹之外,部分患者可出現(xiàn)胃腸道的癥狀,如腹痛,腹瀉,惡心,嘔吐,臨床上將這一特殊類型的蕁麻疹稱為腹型蕁麻疹。這部分患者往往急性發(fā)病,臨床表現(xiàn)和癥狀通常較為嚴(yán)重,但其發(fā)病模式和誘因尚未完全明確,又易發(fā)生漏診和誤診,在治療方面更無(wú)規(guī)范可依,因此給患兒帶來(lái)了較大的痛苦。 本研究通過(guò)回顧性研究和前瞻性研究分別搜集兒童急性蕁麻疹病例,分析兒童急性蕁麻疹患者的臨床資料,明確兒童急性蕁麻疹的誘發(fā)因素、臨床表現(xiàn)特點(diǎn),并優(yōu)化糖皮質(zhì)激素的臨床治療方案。 回顧性分析研究共入組14歲以下的兒童急性蕁麻疹患兒共106例,統(tǒng)計(jì)患兒的一般信息,臨床癥狀,實(shí)驗(yàn)室檢查,糖皮質(zhì)激素應(yīng)用方案等。其中男性患兒61例(57.5%),女性患兒45例(42.5%),平均年齡為6.41±3.72歲,平均住院時(shí)間為7.02±3.55天。其中伴發(fā)腹部癥狀患者50例,僅表現(xiàn)皮膚癥狀的患者56例。106例患兒中共有36例患兒發(fā)病前有食物、藥物、感染、化學(xué)物質(zhì)等誘因。以蕁麻疹活動(dòng)指數(shù)(Urticaria Activity Scores, UAS)評(píng)分,共76例患兒評(píng)為臨床表現(xiàn)嚴(yán)重病例。50例伴發(fā)腹部癥狀的患者中,共有48例(45.28%)有腹痛癥狀,其中重度腹痛8例(7.55%),中度腹痛23例(21.70%),輕度腹痛17例(16.04%)。有22例(20.75%)伴有嘔吐,8例(7.55%)伴有腹瀉,和4例(3.77%)伴有惡心。有10例患者以腹痛作為首發(fā)癥狀,占所有伴發(fā)腹部癥狀患者20%,腹痛與皮膚癥狀出現(xiàn)的平均間隔時(shí)間為34.08±26.15小時(shí)。 106例患兒中,僅13例可單用抗組胺藥物控制,余93例均應(yīng)用糖皮質(zhì)激素治療。分析激素用量發(fā)現(xiàn),以強(qiáng)的松用量計(jì)算,糖皮質(zhì)激素平均最高劑量為每天1.64±0.83mg/kg,最高劑量平均應(yīng)用時(shí)間為3.97±1.64天,皮疹平均消失時(shí)間為4.77±2.24天,腹痛患者腹痛癥狀平均消失時(shí)間3.30±1.70天。 腹型與非腹型患兒的糖皮質(zhì)激素使用劑量在統(tǒng)計(jì)學(xué)上無(wú)差異,P0.05；而在減量時(shí)間上兩組存在明顯差異,腹型組糖皮質(zhì)激素平均最高劑量應(yīng)用時(shí)間(4.48±1.76天)明顯長(zhǎng)于非腹型組(3.51±1.39天),腹型組患兒減量晚于非腹型組,P0.05。 前瞻性研究的部分共入組14歲以下的兒童急性蕁麻疹患兒共241例,其中男性患兒146例(60.6%),女性患兒95例(39.4%),依據(jù)臨床表現(xiàn)分為腹型組和非腹型組,腹型70例,非腹型171例。分析兩組兒童發(fā)病誘因、臨床表現(xiàn)。并在第一部分調(diào)查的基礎(chǔ)上,根據(jù)病情在腹型組患兒中應(yīng)用糖皮質(zhì)激素,劑量以強(qiáng)的松當(dāng)量lmg/kg/d,若12小時(shí)癥狀不緩解,加量至強(qiáng)的松當(dāng)量1.6mg/kg/d。觀察小劑量糖皮質(zhì)激素是否可控制腹型蕁麻疹癥狀,并比較低劑量組患兒和高劑量組患兒的激素應(yīng)用時(shí)間、皮疹消失時(shí)間和腹痛消失時(shí)間。分別比較激素應(yīng)用劑量和時(shí)間與年齡、臨床表現(xiàn)之間的關(guān)系,優(yōu)化兒童急性腹型蕁麻疹糖皮質(zhì)激素治療方案。 241例患兒中,首發(fā)病例有193例,再發(fā)病例48例,再發(fā)病例的首次發(fā)病平均年齡為3.19±2.10歲。就診前平均病程5.23天。共有113例患兒發(fā)病前曾有不同類型的感染,其中腹型組39例(55.7%),非腹型組74例(43.3%),并以呼吸道感染最為常見(jiàn)。兩組患兒在感染誘因中存在統(tǒng)計(jì)學(xué)差異,腹型組患兒發(fā)疹前感染率明顯高于非腹型組。藥物是兒童發(fā)病的第二大誘因,共有42名患兒發(fā)病前有用藥史,以抗生素類藥物最多見(jiàn),其次為非甾體類抗炎藥。 以UAS評(píng)分評(píng)價(jià)嚴(yán)重程度,70例腹型患兒中臨床表現(xiàn)嚴(yán)重者為48人(68.6%),中度者20人(28.6%),輕度者2人(2.86%)。以皮疹為首發(fā)癥狀的占64.3%(45例),以腹痛為首發(fā)癥狀的占14.3%(10例),兩者同時(shí)發(fā)生的占21.4%(15例)。重度腹痛9人(12.9%),中度腹痛22人(31.4%),輕度腹痛38人(54.3%)。非腹型組中臨床表現(xiàn)嚴(yán)重組54人(31.6%),中度組79人(46.2%),輕度組38人(22.2%)。腹型患兒在風(fēng)團(tuán)數(shù)量及瘙癢程度上明顯重于非腹型患兒,兩組數(shù)據(jù)有統(tǒng)計(jì)學(xué)差異(P0.05)。 治療方面,腹型組70例患兒中,僅13例可單用抗組胺藥物控制,余57例均有應(yīng)用糖皮質(zhì)激素。但是非腹型組則大部分(142例)可用抗組胺藥物控制。腹型57例應(yīng)用激素的患兒中,35例(61.4%)應(yīng)用低劑量激素治療(強(qiáng)的松當(dāng)量1mg/kg/d)即可控制,另有22例(38.6%)患兒需應(yīng)用高劑量激素治療(強(qiáng)的松當(dāng)量1.6mg/kg/d)。結(jié)果顯示：兩組患兒在皮疹評(píng)分及腹痛評(píng)分上無(wú)差異,在應(yīng)用不同劑量激素后癥狀均可緩解,且平均最高劑量應(yīng)用時(shí)間,皮疹消失時(shí)間,腹痛消失時(shí)間均無(wú)統(tǒng)計(jì)學(xué)差異,P0.05。 通過(guò)以上研究發(fā)現(xiàn),感染、藥物是兒童急性蕁麻疹的主要發(fā)病誘因。部分患兒以腹痛為首發(fā)癥狀,導(dǎo)致誤診或漏診；兒童急性腹型蕁麻疹患兒應(yīng)用抗組胺藥物控制不佳的情況下,應(yīng)及早應(yīng)用糖皮質(zhì)激素治療。大部分患兒小劑量激素應(yīng)用(1mg/kg/d)即可控制,無(wú)需大劑量應(yīng)用。臨床觀察12小時(shí),若癥狀不緩解,糖皮質(zhì)激素劑量可加量至強(qiáng)的松當(dāng)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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.24
本文編號(hào)：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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.24
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 謝廣清;張勝;龍曉玲;阮健;梁展圖;付四毛;;兒童腹型蕁麻疹5例胃鏡特征和臨床分析[J];廣東醫(yī)學(xué);2010年23期
2 陳明春;黃櫻櫻;鄒勇男;;慢性蕁麻疹與乙型肝炎病毒感染的關(guān)系[J];中國(guó)熱帶醫(yī)學(xué);2009年09期
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