Zhu Ying, Dong Yang, Xu Da-Liang, Jiang Jia-Yun, Wu Lin, Ke Rui-Juan, Fang Shao-Han, Peng Yin
Department of Nephrology, Anhui Provincial Children′s Hospital, Hefei 230051, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2018 May;20(5):378-382. doi: 10.7499/j.issn.1008-8830.2018.05.008.
To study the clinical effect and mechanism of hemoperfusion (HP) in the treatment of children with severe abdominal Henoch-Schönlein purpura (HSP).
A total of 24 children with severe abdominal HSP were divided into two groups: conventional treatment and HP (n=12 each). Ten healthy children who underwent physical examination were enrolled as the control group. Before and after treatment, chemiluminescence was used to measure the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α); thiobarbituric acid colorimetry was used to measure the plasma level of malondialdehyde (MDA); the hydroxylamine method was used to measure the plasma level of superoxide dismutase (SOD); chemical colorimetry was used to measure the plasma level of total anti-oxidant capability (T-AOC).
Compared with the control group, the conventional treatment and HP groups had significantly higher IL-6, TNF-α, and MDA levels and significantly lower SOD and T-AOC levels before treatment (P<0.05), but there were no significant differences between the conventional treatment and HP groups (P>0.05). After treatment, the conventional treatment and HP groups had significant reductions in IL-6, TNF-α, and MDA levels and significant increases in SOD and T-AOC levels (P<0.05). The HP group had significantly greater changes than the conventional treatment group; however, there were still significant differences in these indices between the HP and control groups (P<0.05). Compared with the HP group, the conventional treatment group had a significantly lower percentage of children with disappearance of digestive tract symptoms at 4 days after treatment and significantly longer time to disappearance of rash and digestive tract symptoms (P<0.05). Compared with the conventional treatment group, the HP group had a significantly lower amount of glucocorticoid used during treatment and a significantly lower percentage of children who experienced hematuria and/or proteinuria within 6 months of the disease course (P<0.05). There were no significant differences between the two groups in length of hospital stay and recurrence rates of rash and abdominal pain within 6 months of the disease course.
HP can reduce the amount of glucocorticoid used during treatment and the incidence rate of kidney injury in children with severe abdominal HSP, possibly by eliminating IL-6, TNF-α, and MDA.
研究血液灌流（HP）治疗儿童重症腹型过敏性紫癜（HSP）的临床疗效及机制。
将24例重症腹型HSP患儿分为两组：常规治疗组和HP组（每组12例）。选取10例接受体检的健康儿童作为对照组。治疗前后，采用化学发光法检测血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平；采用硫代巴比妥酸比色法检测血浆丙二醛（MDA）水平；采用羟胺法检测血浆超氧化物歧化酶（SOD）水平；采用化学比色法检测血浆总抗氧化能力（T-AOC）水平。
与对照组相比，常规治疗组和HP组治疗前IL-6、TNF-α和MDA水平显著升高，SOD和T-AOC水平显著降低（P<0.05），但常规治疗组和HP组之间无显著差异（P>0.05）。治疗后，常规治疗组和HP组IL-6、TNF-α和MDA水平显著降低，SOD和T-AOC水平显著升高（P<0.05）。HP组的变化明显大于常规治疗组；然而，HP组与对照组之间这些指标仍存在显著差异（P<0.05）。与HP组相比，常规治疗组治疗后4天消化道症状消失的患儿比例显著较低，皮疹和消化道症状消失的时间显著延长（P<0.05）。与常规治疗组相比，HP组治疗期间使用的糖皮质激素量显著较低，病程6个月内出现血尿和/或蛋白尿的患儿比例显著较低（P<0.05）。两组在住院时间以及病程6个月内皮疹和腹痛的复发率方面无显著差异。
HP可减少治疗期间糖皮质激素的用量，并降低重症腹型HSP患儿肾损伤的发生率，可能是通过清除IL-6、TNF-α和MDA实现的。
