血液灌流联合血液透析治疗变态反应性紫癜病的疗效观察

目的观察血液灌流（hemoperfusion,HP）联合血液透析（hemodialysis,HD）对变态反应性紫癜病（Henoch-Schonleinpurpura,HSP）的临床疗效。方法选取2009年2月-2010年8月入住江西省儿童医院肾脏科重症HSP患儿40例,按随机数字表法分为治疗组20例,对照组20例,两组均使用激素、西咪替丁、葡萄糖酸钙及低分子肝素钙等常规治疗,治疗组加用HP＋HD联合治疗,每次2h,每日1次,连用3d。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-1（IL-1）、肿瘤坏死因子α（TNF-α）浓度。结果治疗组相关临床症状改善时间较对照组明显缩短（P〈0.01）;治疗组治疗后患儿血清IL-1、TNF-α浓度较治疗前显著降低,且降低幅度较对照组更明显（P〈0.01）。结论HP联合HD治疗重症过敏性紫癜患者有一定疗效,能较快的改善患者的临床症状,其机制可能与清除血液中的炎症介质有关。

Therapeutic effect of hemoperfusion combining with hemodialysis on refractory Henoch-Schonlein purpura in children

Objective To investigate the clinical effect of hemoperfusion combined with hemodialysis in severe allergic purpura.Methods 40 children with severe allergic purpura were enrolled,and randomly divited into treatment group（n=20） and control group（n=20）.All children were treated with Glucocorticoid,Cimetidine,calcium gluconate and low molecular weight hepacarin.In the treatment group,children were also received hemoperfusion combined with hemodialysis.The related symptons,serum concentration of interleukin-1（IL-1）,tumor necrosis factor-α（TNF-a） were observed.Results The relieving,disappear time of HSP related symptoms in treatment group were shorter than those of control group（P〈0.01）;Treatment group reduced the serum concentrations of IL-1,TNF-α significantly（P〈0.01）,and the effect was evidenter than control group.Conclusion Eliminating blood inflammatory mediators maybe a possible way for Hemoperfusion combined with hemodialysis to alleviate clinical symptoms.