發(fā)布時(shí)間：2018-06-17 09:29

  本文選題：過(guò)敏性紫癜 + 紫癜性腎炎　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：觀察過(guò)敏性紫癜嚴(yán)重病例血液灌流治療前后的臨床癥狀及血清中胰島素樣生長(zhǎng)因子-1、白介素-17含量的變化，探討血液灌流治療過(guò)敏性紫癜嚴(yán)重病例的療效及其可能機(jī)制。方法：收集2012年5月至2014年1月瀘州醫(yī)學(xué)院附屬醫(yī)院兒科住院的40例過(guò)敏性紫癜嚴(yán)重病例，并分為2組：A組、B組，每組各20例。A組僅采取傳統(tǒng)治療（包括抗炎、抗凝、抗過(guò)敏等對(duì)癥治療）；B組采取血液灌流聯(lián)合傳統(tǒng)治療。同時(shí)收集我院門(mén)診體檢中心的15例健康兒童作為正常對(duì)照組（C組）。觀察并記錄A、B兩組患兒治療前后的腹痛、血便、皮疹、關(guān)節(jié)腫痛、血管神經(jīng)性水腫的變化，以及尿微量白蛋白、尿紅細(xì)胞計(jì)數(shù)的檢查結(jié)果，并統(tǒng)計(jì)住院時(shí)間。A組在治療前、后采集靜脈全血3ml；B組在血液灌流治療前、第一次、第二次、第三次血液灌流結(jié)束時(shí)采集靜脈全血3ml；C組僅體檢時(shí)采集一次靜脈全血3ml。將上訴標(biāo)本進(jìn)行離心，取上清液，采用酶聯(lián)免疫吸附試驗(yàn)（ELISA）測(cè)定每例標(biāo)本中的胰島素樣生長(zhǎng)因子-1、白介素-17的含量，分別比較治療前后各項(xiàng)檢測(cè)指標(biāo)及臨床癥狀在各組間、組內(nèi)的差異，并對(duì)比A、B兩組的住院時(shí)間。結(jié)果：40例過(guò)敏性紫癜嚴(yán)重病例在治療后腹痛、血便、皮疹、關(guān)節(jié)腫痛、血管神經(jīng)性水腫均得到緩解，以B組緩解更快，且住院時(shí)間縮短；但反映腎臟受累的尿微量白蛋白、尿紅細(xì)胞計(jì)數(shù)在A、B兩組治療前后的差異無(wú)統(tǒng)計(jì)學(xué)意義。治療前A、B兩組血清中的胰島素樣生長(zhǎng)因子-1、白介素-17含量均顯著高于正常對(duì)照組， A、B兩組組間差異無(wú)統(tǒng)計(jì)學(xué)意義；治療后A、B組患兒上述細(xì)胞因子的含量均較治療前明顯下降，，差異有統(tǒng)計(jì)學(xué)意義（P 0.01）；而B(niǎo)組在第三次血液灌流結(jié)束后的下降較A組更顯著，差異有統(tǒng)計(jì)學(xué)意義(P 0.01)；A、B兩組在治療后各細(xì)胞因子仍高于C組,差異有統(tǒng)計(jì)學(xué)意義(P 0.01)；B組患兒在三次血液灌流后上述細(xì)胞因子較治療前均有下降趨勢(shì)，但第一次血液灌流后的下降無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；第二次、第三次灌流后的下降均有統(tǒng)計(jì)學(xué)意義（P0.05）；各細(xì)胞因子在三次血液灌流結(jié)束后的進(jìn)行兩兩比較，僅第一次與第二次的比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。伴有腎臟受累（尿微量白蛋白及尿紅細(xì)胞計(jì)數(shù)陽(yáng)性）的患兒,胰島素樣生長(zhǎng)因子-1、白介素-17的含量均較不伴腎臟受累的明顯升高，差異有統(tǒng)計(jì)學(xué)意義（P 0.01）。上訴指標(biāo)進(jìn)行相關(guān)性分析提示胰島素樣生長(zhǎng)因子-1、白介素-17之間存在正相關(guān)關(guān)系，有統(tǒng)計(jì)學(xué)意義(p0.05)；尿微量白蛋白與胰島素樣生長(zhǎng)因子-1、白介素-17的含量呈正相關(guān)關(guān)系,有統(tǒng)計(jì)學(xué)意義(p0.05)；尿紅細(xì)胞計(jì)數(shù)與胰島素樣生長(zhǎng)因子-1、白介素-17含量呈相關(guān)關(guān)系，但均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。結(jié)論：1.過(guò)敏性紫癜嚴(yán)重病例血清胰島素樣生長(zhǎng)因子-1、白介素-17的含量較正常兒童均明顯升高，上述細(xì)胞因子可能參與了過(guò)敏性紫癜血管炎癥反應(yīng)的發(fā)生發(fā)展；2.血液灌流聯(lián)合傳統(tǒng)治療對(duì)于過(guò)敏性紫癜嚴(yán)重病例的近期療效明顯優(yōu)于單純傳統(tǒng)治療；3.血液灌流聯(lián)合傳統(tǒng)治療在清除過(guò)敏性紫癜嚴(yán)重病例血液中的炎癥介質(zhì)胰島素樣生長(zhǎng)因子-1、白介素-17，平衡免疫功能方面優(yōu)于單純傳統(tǒng)治療；4.腎臟受累的過(guò)敏性紫癜患兒血清中胰島素樣生長(zhǎng)因子-1、白介素-17的含量均較不伴腎臟受累者高；5.血液灌流聯(lián)合傳統(tǒng)治療及單純傳統(tǒng)治療，在近期均未能顯示出腎臟保護(hù)作用。血液灌流聯(lián)合傳統(tǒng)治療能否改善紫癜性腎炎的預(yù)后，仍需進(jìn)一步的研究及遠(yuǎn)期隨訪。
[Abstract]:Objective: To observe the clinical symptoms, the changes of serum insulin like growth factor -1 (IGF) and the content of il--17 in serum before and after hemoperfusion in severe cases of anaphylactoid purpura, and to explore the effect and possible mechanism of hemoperfusion in the treatment of allergic purpura severe cases. Methods: from May 2012 to January 2014, the children of Affiliated Hospital of Luzhou Medical College were collected. 40 cases of anaphylactoid purpura severe cases in the hospital were divided into 2 groups: group A and group B, 20 cases in each group of.A were treated with traditional treatment (including anti-inflammatory, anticoagulant, antiallergic and other symptomatic treatment); group B was treated with blood perfusion combined with traditional treatment. At the same time, 15 healthy children in the medical center of our hospital were collected as the normal control group (group C). A, B two groups of children with abdominal pain, blood stool, rash, joint swelling and pain, changes in vascular neurodropsy, urine microalbumin, urine red blood cell count examination results, and the time of hospitalization time.A group before the treatment, after the collection of venous blood 3ml; group B before the blood perfusion treatment, the first, second, third blood perfusion ends. The total venous blood 3ml was collected and the C group collected only one vein whole blood 3ml. to centrifuge the appellate specimen and take the supernatant, and use the enzyme linked immunosorbent assay (ELISA) to determine the insulin like growth factor -1 and the content of interleukin -17 in each sample. A, B two groups of hospitalization time. Results: 40 cases of anaphylactoid purpura severe cases of abdominal pain after treatment, blood stool, rash, joint swelling and pain, vascular neuroedema were alleviated, B group remission faster, and hospitalization time shorter; but reflect the kidney involvement of urine microalbumin, urine red blood cell count in the A, B two groups before and after treatment The serum levels of IGF -1 and interleukin -17 in the serum of A and B two before treatment were significantly higher than those in the normal control group, and there was no significant difference between the two groups of A and B. The contents of the cytokines in the A and B group were significantly lower than those before the treatment (P 0.01), while the B group was in the B group. After the third blood perfusion, the decrease was more significant than that in the A group (P 0.01); A, B two groups were still higher than the C group after treatment (P 0.01). The above cytokines in the B group were decreased after three blood perfusion, but the decrease after the first blood perfusion was no longer than before the treatment. Statistical significance (P0.05); second and third times after perfusion were statistically significant (P0.05); each cell factor was compared at the end of the three hemoperfusion, and there was no significant difference between the first and second times (P0.05). The content of ISL like growth factor -1 and interleukin -17 was significantly higher than that of renal involvement, the difference was statistically significant (P 0.01). The correlation analysis of the appeal indicators suggested that there was a positive correlation between insulin like growth factor -1, interleukin -17, and statistically significant (P0.05); urine microalbumin and insulin like growth factor -1 The content of interleukin -17 was positively correlated (P0.05), and the urine red cell count was related to the content of insulin like growth factor -1 and interleukin -17, but there was no statistical significance (P0.05). Conclusion: 1. the serum insulin like growth factor -1 and the content of interleukin -17 in the severe cases of Henoch Schonlein purpura and the content of interleukin -17 are more obvious than those of normal children. The above cytokines may be involved in the development of anaphylactoid purpura vascular inflammation, 2. hemoperfusion combined with traditional treatment is obviously better than traditional treatment for the severe cases of anaphylactoid purpura; 3. hemoperfusion combined with traditional treatment in the removal of inflammatory mediators in the blood of allergic purpura severe cases ISL like growth factor -1, il--17, balanced immune function is superior to simple traditional treatment; 4. the serum levels of IGF -1 and il--17 in children with Henoch Schonlein purpura with renal involvement are higher than those without renal involvement; 5. the combination of traditional and traditional treatment of hemoperfusion can not be shown in the near future. Renal protection. Whether hemoperfusion combined with traditional treatment can improve the prognosis of Henoch Schonlein purpura nephritis still needs further study and long-term follow-up.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725.5

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