Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Clin Rheumatol. 2010 Apr;29(4):369-74. doi: 10.1007/s10067-009-1329-2. Epub 2009 Dec 23.
The objective of this study was to identify the most effective treatment by evaluating the different therapies used to treat mild, moderate, and severe Henoch-Schönlein purpura (HSP) patients. We performed a retrospective study of children discharged with a diagnosis of HSP. The study group consisted of 425 children divided into mild, moderate, and severe condition groups. Different therapeutic protocols of hydrocortisone sodium succinate (HCSS) therapy, methylprednisolone (MP) pulse therapy, and MP combination with tripterygium glycoside (TG) therapy were used to treat the different groups. The evaluation of curative effect was performed. After 4 weeks, all patients with no obvious recovery were treated by strengthening the different treatment intervention. The remission time of skin, joint, and gastrointestinal manifestations was evaluated, and the results of the follow-up were analyzed (remission time of proteinuria, relapse, and side effects of therapy). After 4 weeks, in the mild group, the difference of the curative effect between HCSS and MP therapy was not statistically significant. Moderate HSP patients were more likely to respond to MP therapy than HCSS therapy (P < 0.05). Severe HSP patients were more likely to respond to MP combination with TG than single MP therapy (P < 0.05). At last follow-up, they all had normal urinalysis. In the moderate HSP group, the mean duration of proteinuria was shorter in the MP pulse therapy group than in the HCSS therapy group (P < 0.05). In the mild group, the mean duration of purpura was shorter in HCSS therapy group than in the MP pulse therapy group (P < 0.05). At last follow-up, 99 patients had recurrences of purpura and/or proteinuria and 41 patients had liver functional impairment and/or hypertension. The relapse and side effects were all satisfactorily controlled, and the rates of relapse and side effects did not differ between groups with different therapies (P > 0.05). Our study has demonstrated a superior effect for HCSS therapy in patients with mild HSP disease, for MP therapy in patients with moderate disease, and for MP combined with TG therapy in patients with severe disease. MP therapy administered initially reduces the duration of urinary protein abnormality. The therapeutic protocols did not increase the risk of relapse and were safe.
本研究旨在通过评估治疗轻度、中度和重度亨诺克-舒恩莱因紫癜（HSP）患者的不同疗法，确定最有效的治疗方法。我们对出院诊断为 HSP 的儿童进行了回顾性研究。研究组包括 425 名儿童，分为轻度、中度和重度组。不同的治疗方案包括琥珀酸氢化可的松钠（HCSS）治疗、甲基强的松龙（MP）脉冲治疗和 MP 联合雷公藤糖苷（TG）治疗，用于治疗不同组的患者。评估了疗效。4 周后，对所有无明显恢复的患者进行强化不同治疗干预。评估皮肤、关节和胃肠道表现的缓解时间，并分析随访结果（蛋白尿缓解时间、复发和治疗副作用）。4 周后，在轻度组中，HCSS 和 MP 治疗的疗效差异无统计学意义。中度 HSP 患者对 MP 治疗的反应优于 HCSS 治疗（P<0.05）。重度 HSP 患者对 MP 联合 TG 治疗的反应优于单一 MP 治疗（P<0.05）。最后随访时，所有患者的尿液分析均正常。在中度 HSP 组中，MP 脉冲治疗组蛋白尿的平均持续时间短于 HCSS 治疗组（P<0.05）。在轻度组中，HCSS 治疗组的紫癜平均持续时间短于 MP 脉冲治疗组（P<0.05）。最后随访时，99 例患者出现紫癜和/或蛋白尿复发，41 例患者出现肝肾功能损害和/或高血压。复发和副作用均得到满意控制，不同治疗组的复发和副作用发生率无差异（P>0.05）。我们的研究表明，HCSS 治疗对轻度 HSP 患者有效，MP 治疗对中度患者有效，MP 联合 TG 治疗对重度患者有效。初始 MP 治疗可缩短尿蛋白异常持续时间。治疗方案并未增加复发风险，且安全。
