目的 对比血液灌流(HP)与丙种球蛋白治疗儿童过敏性紫癜伴消化道出血的临床疗效及安全性。 方法 病例对照研究。对2015年1月至2019年12月中国医科大学附属盛京医院小儿肾脏风湿免疫科诊断过敏性紫癜及消化道出血的患儿39例进行回顾性分析。根据患儿是否行HP、丙种球蛋白治疗分为HP组和丙种球蛋白组，收集患儿临床资料，并对患儿进行6个月的随访调查，了解有无消化道出血复发及肾脏损伤。应用Fisher′s精确检验、两独立样本t检验、Mann-Whitney U检验、Kruskal-Wallis H检验、方差分析等方法比较组间差异。 结果 1．HP组20例，丙种球蛋白组19例，丙种球蛋白组年龄小于HP治疗组；2。2组患儿均有明显腹痛及消化道出血，部分患儿伴血管神经性水肿、肉眼血尿等；3。实验室指标比较：2组治疗前炎症指标[白细胞(WBC)，C反应蛋白(CRP)]、凝血功能指标[纤维蛋白降解产物(FDP)、D－二聚体(DD)]明显升高，但2组间差异无统计学意义(P>0。05)；2组患儿治疗后WBC、CRP、FDP、DD较治疗前下降，但2组间差异无统计学意义(P>0。05)；4。临床表现比较：入院3 d内HP组腹痛缓解时间明显短于丙种球蛋白组[1。00(1。00，1。00) d比2。00(1。75，6。50)d，P＝0。011]；2组消化道出血停止时间差异无统计学意义(P>0。05)；5。住院天数比较：3 d内应用HP与4～7 d、≥10 d应用组相比住院天数明显减少[(16。89±4。99) d比(19。20±2。39) d比(34。83±8。40) d，P<0。05]，丙种球蛋白组组间及组内比较差异均无统计学意义(均P>0。05)；6。住院费用比较：3 d内应用HP与4～7 d、≥10 d应用组相比费用明显减少[25 554。03(22 168。61，28 527。30)元比33 619。48(32 661。18，36 971。47)元比51 290。34(34 163。04，64 772。66)元，P<0。05]，应用丙种球蛋白组组间及组内比较差异均无统计学意义(均P>0。05)；7。激素用量比较：2组患儿初始激素剂量、丙种球蛋白/HP治疗前剂量、丙种球蛋白/HP治疗后剂量结果差异均无统计学意义(均P>0。05)，2种治疗方法安全性也无差异，丙种球蛋白与HP组内激素剂量治疗后较治疗前减少，差异有统计学意义(P<0。001)。 结论 对于伴消化道出血的重症过敏性紫癜患儿，尽早采用血液净化治疗，可以快速缓解临床症状，减少住院天数及住院费用。对于无血液净化条件及不适宜应用血液净化的病例，应用丙种球蛋白治疗为另一种选择方法。 Objective To compare the clinical efficacy and safety of hemoperfusion (HP) and gammaglobulin on the treatment of Henoch-Schönlein purpura (HSP) with gastrointestinal bleeding in children。 Methods Case-control study。A total of 39 HSP children combined with gastrointestinal bleeding diagnosed in the Department of Pediatric Nephrology， Rheumatology and Immunology， Shengjing Hospital of China Medical University from January 2015 to December 2019 were retrospectively recruited。They were divided into the HP group and the gammaglobulin group according to the therapeutic strategy。Clinical data were collected， and a 6-month follow-up survey was conducted for monitoring the relapse of gastrointestinal bleeding and the occurrence of kidney injury。The differences between groups were compared by Fisher′s exact test， two independent samples t-test， Mann-Whitney U-test， Kruskal-Wallis H-test， and One-Way ANOVA。 Results (1) There were 20 cases in the HP group and 19 cases were included in the gammaglobulin group。The gammaglobulin group was younger than the HP treatment group。(2) In addition to gastrointestinal bleeding， children in both groups had other clinical symptoms， such as abdominal pain， angioneurotic edema， and hematuria。(3)Comparison of laboratory indexes: Inflammatory indexes: white blood cell count (WBC)， C-creative protein (CRP) and coagulation function indexes: fibrin degradation products (FDP)， D-dimer (DD) were significantly elevated before treatment in the 2 groups， and there was no difference between the 2 groups (P>0。05) WBC， CRP and FDP， DD declined in the 2 groups after treatment compared with the former， and there was no difference between the 2 groups (P>0。05) (4) Comparison of clinical manifestations: when HP was applied with gammaglobulin in the treatment window within 3 d， the difference in the time of abdominal pain relief in the HP group was shorter than that of the gammaglobulin group [1。00(1。00， 1。00) dvs。2。00(1。75， 6。50) d， P=0。011] comparing the time of gastrointestinal bleeding stopping when HP was applied with gammaglobulin comparison， the difference in gastrointestinal bleeding cessation time was not statistically significant (P>0。05) (5) Comparison of hospitalization time: within 3 d application of HP compared with other window period hospitalization time were significantly reduced [(16。89±4。99) d than (19。20±2。39) d than (34。83±8。40) d， bothP<0。05] (6) Comparison of hospitalization costs: within 3 d application of HP compared with other window period hospitalization costs were significantly reduced [25 554。03 (22 168。61， 28 527。30) yuan than 33 619。48 (32 661。18， 36 971。47) yuan than 51 290。34 (34 163。04， 64 772。66) yuan， bothP<0。05] There were no statistically significant difference in the hospitalization time and hospitalization cost between and within the gammaglobulin group (allP>0。05) (7) Comparison of hormone dosages: the difference in the results of the initial dose of hormone use， pre-treatment dose of gammaglobulin/HP， and post-treatment dose of gammaglobulin/HP between the two groups of children was not statistically significant(allP>0。05)。 Safety profile was comparable between groups。The difference in hormone dosage before and after treatment within the gammaglobulin and HP treatment group was statistically different (P<0。001)。 Conclusions For children with severe HSP accompanied by gastrointestinal bleeding， early treatment with blood purification can rapidly relieve clinical symptoms and reduce the number of hospital days and hospitalization costs。For cases where blood purification is not available or suitable， gammaglobulin treatment is another option。
Single-center controlled study for application of hemoperfusion and versus gammaglobulin for the treatment of Henoch-Sch?nlein purpura combined gastrointestinal bleeding in children
Objective To compare the clinical efficacy and safety of hemoperfusion (HP) and gammaglobulin on the treatment of Henoch-Schönlein purpura (HSP) with gastrointestinal bleeding in children. Methods Case-control study.A total of 39 HSP children combined with gastrointestinal bleeding diagnosed in the Department of Pediatric Nephrology, Rheumatology and Immunology, Shengjing Hospital of China Medical University from January 2015 to December 2019 were retrospectively recruited.They were divided into the HP group and the gammaglobulin group according to the therapeutic strategy.Clinical data were collected, and a 6-month follow-up survey was conducted for monitoring the relapse of gastrointestinal bleeding and the occurrence of kidney injury.The differences between groups were compared by Fisher′s exact test, two independent samples t-test, Mann-Whitney U-test, Kruskal-Wallis H-test, and One-Way ANOVA. Results (1) There were 20 cases in the HP group and 19 cases were included in the gammaglobulin group.The gammaglobulin group was younger than the HP treatment group.(2) In addition to gastrointestinal bleeding, children in both groups had other clinical symptoms, such as abdominal pain, angioneurotic edema, and hematuria.(3)Comparison of laboratory indexes: Inflammatory indexes: white blood cell count (WBC), C-creative protein (CRP) and coagulation function indexes: fibrin degradation products (FDP), D-dimer (DD) were significantly elevated before treatment in the 2 groups, and there was no difference between the 2 groups (P>0.05) WBC, CRP and FDP, DD declined in the 2 groups after treatment compared with the former, and there was no difference between the 2 groups (P>0.05) (4) Comparison of clinical manifestations: when HP was applied with gammaglobulin in the treatment window within 3 d, the difference in the time of abdominal pain relief in the HP group was shorter than that of the gammaglobulin group [1.00(1.00, 1.00) dvs.2.00(1.75, 6.50) d, P=0.011] comparing the time of gastrointestinal bleeding stopping when HP was applied with gammaglobulin comparison, the difference in gastrointestinal bleeding cessation time was not statistically significant (P>0.05) (5) Comparison of hospitalization time: within 3 d application of HP compared with other window period hospitalization time were significantly reduced [(16.89±4.99) d than (19.20±2.39) d than (34.83±8.40) d, bothP<0.05] (6) Comparison of hospitalization costs: within 3 d application of HP compared with other window period hospitalization costs were significantly reduced [25 554.03 (22 168.61, 28 527.30) yuan than 33 619.48 (32 661.18, 36 971.47) yuan than 51 290.34 (34 163.04, 64 772.66) yuan, bothP<0.05] There were no statistically significant difference in the hospitalization time and hospitalization cost between and within the gammaglobulin group (allP>0.05) (7) Comparison of hormone dosages: the difference in the results of the initial dose of hormone use, pre-treatment dose of gammaglobulin/HP, and post-treatment dose of gammaglobulin/HP between the two groups of children was not statistically significant(allP>0.05). Safety profile was comparable between groups.The difference in hormone dosage before and after treatment within the gammaglobulin and HP treatment group was statistically different (P<0.001). Conclusions For children with severe HSP accompanied by gastrointestinal bleeding, early treatment with blood purification can rapidly relieve clinical symptoms and reduce the number of hospital days and hospitalization costs.For cases where blood purification is not available or suitable, gammaglobulin treatment is another option.
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