探讨血液灌流辅助治疗儿童过敏性紫癜(HSP)的临床价值及治疗指征。

选择2013年4月至2015年4月，于成都市妇女儿童中心医院住院治疗的239例HSP患儿为研究对象。根据患儿疾病严重程度和是否采用血液灌流治疗，将其分为4组：轻症观察组(n＝76，为轻症HSP患儿，采用常规治疗＋血液灌流)，轻症对照组(n＝84，为轻症HSP患儿，采用常规治疗)，重症观察组(n＝47，为重症HSP患儿，采用常规治疗＋血液灌流)及重症对照组(n＝32，为重症HSP患儿，采用常规治疗)。常规治疗包括抗炎、抗过敏、抗凝及对症处理，血液灌流为辅助治疗。回顾性分析239例HSP患儿病例资料，对2组轻症或2组重症HSP患儿急性期治疗后临床症状改善情况等近期疗效指标，以及1年内皮疹复发率及肾脏损害发生率2项远期疗效指标，采用t检验或χ²检验就行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》，并与患儿家属签订知情同意书。

①重症观察组HSP患儿腹痛及血便消失时间、关节肿痛消失时间及皮肤紫癜减轻时间[(4.8±0.6) d、(3.0±0.7) d、(3.4±0.8) d]，均短于重症对照组[(5.8±0.5) d、(4.2±0.8) d、(4.5±0.7) d]，并且差异均有统计学意义(t＝15.499、7.060、6.040，P<0.001)；对2组重症HSP患儿随访1年的皮疹复发率及肾脏损害发生率比较，差异均无统计学意义(P>0.05)。2组轻症HSP患儿上述5项指标比较，差异均无统计学意义(P>0.05)。②重症观察组HSP患儿治疗第7天时，尿微量白蛋白、转铁蛋白、α1微球蛋白、β2微球蛋白，血清白细胞介素(IL)-1及肿瘤坏死因子(TNF)-α水平[(20.6±15.0) mg/L、(6.6±0.6) mg/L、(8.0±1.0) mg/L、(0.32±0.23) mg/L、(6.9±1.6) mg/L、(9.6±2.9) mg/L]，均低于重症对照组[(38.4±10.4) mg/L、(9.0±1.0) mg/L、(10.2±1.7) mg/L、(3.50±1.40) mg/L、(8.3±1.7) mg/L、(12.9±2.8) mg/L]，并且差异均有统计学意义(t＝5.804、13.191、6.686、15.286、3.823、5.004，P<0.001)。2组轻症HSP患儿治疗第7天时上述6项指标比较，差异均无统计学意义(P>0.05)。

血液灌流辅助治疗可缓解重症HSP患儿临床症状、减轻急性肾损伤，但是对轻症或重症HSP患儿皮疹复发及肾脏损伤，尚未发现有预防作用。建议血液灌流仅用于重症HSP患儿的辅助治疗。

To explore the clinical values and therapeutic indications of blood perfusion as secondary treatment of children with Henoch-Schonlein purpura (HSP).

From April 2013 to April 2015, a total of 239 HSP children hospitalized in Chengdu Women′s & Children′s Central Hospital were selected as research subjects. According to their diseases severity and different treatment strategies, they were divided into four groups, including observation group with mild HSP (n=76, children with mild HSP and treated with routine therapy and blood perfusion), control group with mild HSP (n=84, children with mild HSP and treated with routine therapy), and observation group with severe HSP (n=47, children with severe HSP and treated with routine therapy and blood perfusion) and control group with severe HSP (n=32, children with severe HSP and treated with routine therapy) . Routine therapy included antiinflammatory, antianaphylaxis, anticoagulation and symptomatic treatment, and blood perfusion was as adjunctive therapy. Case data of 239 children with HSP were retrospectively analyzed. The evaluating indicators of short-term efficacy of improved clinical symptoms after treatment in acute stage, and 2 long-term efficacies of rash recurrence rates and the incidences of kidney damage in one year between 2 groups of mild or severe HSP children were compared statistically by t test or chi-square test. This study was consistent with the World Medical Association Declaration of Helsinki revised in 2013 and informed consents were signed by the guardians of children.

①The symptoms disappearance time of abdominal pain and bloody stools, and joint pain, and purpura alleviated time in observation group with severe HSP [(4.8±0.6) d, (3.0±0.7) d, (3.4±0.8) d] were all shorter than those in control group with severe HSP [(5.8±0.5) d, (4.2±0.8) d, (4.5±0.7) d], and all the differences were statistically significant (t=15.499, 7.060, 6.040; P<0.001). There were no significant differences between two groups of children with severe HSP in recurrence rates of rashes and incidence rates of renal damage in one year of follow-up (P>0.05). There were no significant differences between two groups of children with mild HSP in above 5 indicators (P>0.05). ②At the 7th day after treatment, the levels of microalbumin, transferrin, α1 and β2 microglobulin in urine, and the serum interleukin (IL)-1 and tumor necrosis factor (TNF)-α in observation group with severe HSP [(20.6±15.0) mg/L, (6.6±0.6) mg/L, (8.0±1.0) mg/L, (0.32±0.23) mg/L, (6.9±1.6) mg/L, (9.6±2.9) mg/L] were all lower than those in control group with severe HSP [(38.4±10.4) mg/L, (9.0±1.0) mg/L, (10.2±1.7) mg/L, (3.50±1.40) mg/L, (8.3±1.7) mg/L, (12.9±2.8) mg/L], and the differences were statistically significant (t=5.804, 13.191, 6.686, 15.286, 3.823, 5.004; P<0.001). There were no significant differences between two groups of children with mild HSP in above 6 indicators (P>0.05).

Blood perfusion can relieve clinical symptoms and alleviate acute kidney injury of children with severe HSP, but it has not yet been found that blood perfusion has a preventive effect on rash recurrence and occurrence of renal injury neither in children with mild HSP nor in children with severe HSP. It is recommended that blood perfusion should only be used for adjuvant treatment for children with severe HSP.