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目的观察雷公藤总苷(TWP)治疗儿童过敏性紫癜(HSP)难治性皮肤紫癜的疗效,同时观察TWP预防HSP肾损害的作用。方法 67例单纯性皮肤紫癜患儿经一般治疗2周后皮疹仍反复发作,且无肾损伤患儿随机分为泼尼松治疗组32例(泼尼松1 mg.kg-1.d-1,最大量不超过60 mg.d-1,疗程2周),TWP治疗组35例(TWP1 mg.kg-1.d-1,最大量不超过45 mg.d-1,疗程2周),观察2组患儿疗效、HSP并发症发生情况及TWP的不良反应。结果 1.治疗疗效:泼尼松治疗组皮疹治疗有效率62.50%,紫癜消退时间(8.13±2.12)d;TWP治疗组有效率85.71%,紫癜消退时间(5.63±1.97)d,2组有效率及紫癜消退时间比较差异均有统计学意义(χ2=4.758、t=5.003,Pa<0.05)。治疗后,泼尼松治疗组患儿皮疹复发次数为(4.32±1.68)次,TWP治疗组皮疹复发次数为(3.01±2.14)次,2组比较差异有统计学意义(t=2.769,P<0.05)。2.并发症和不良反应:泼尼松治疗组患儿肾损害发生率为18.75%,消化道及关节症状发生率分别为46.88%、34.38%;TWP治疗组患儿肾损害发生率为14.29%,消化道及关节症状发生率分别为28.57%、17.14%,2组比较差异均无统计学意义(Pa>0.05)。随访期间,TWP治疗患儿血常规及肝肾功能无异常。结论 TWP治疗儿童HSP难治性皮肤紫癜疗效优于糖皮质激素。TWP短程治疗具有早期预防HSP肾损害的作用,且无明显不良反应。
Objective To observe the curative effect of TWP on refractory purpura in children with Henoch-Schonlein Purpura (HSP). At the same time observe the effect of TWP in preventing HSP nephropathy. Methods A total of 67 children with purpura of simple skin were recurrent rash after 2 weeks of general treatment. Children without renal injury were randomly divided into prednisone group (prednisone 1 mg.kg-1.d-1 (TWP1 mg.kg-1.d-1, maximal dose not more than 45 mg.d-1 for 2 weeks), TWP treatment group (TWP1 mg.kg-1.d-1, maximal dose not exceeding 60 mg.d- The curative effect, HSP complication and adverse reactions of TWP in two groups were observed. Results 1. Therapeutic effect: The effective rate of skin rash in prednisone treatment group was 62.50%, the purpura regression time was (8.13 ± 2.12) d, the effective rate of TWP treatment group was 85.71%, purpura regression time was 5.63 ± 1.97 d, And purpura regression time differences were statistically significant (χ2 = 4.758, t = 5.003, Pa <0.05). After treatment, the frequency of rash in the prednisone treatment group was (4.32 ± 1.68) times and that in the TWP treatment group was (3.01 ± 2.14) times. There was significant difference between the two groups (t = 2.769, P < 0.05). 2.Complications and adverse reactions: the incidence of renal damage in children with prednisone treatment was 18.75%, the incidence of gastrointestinal and joint symptoms were 46.88%, 34.38% respectively; the incidence of renal damage in children treated with TWP was 14.29% , Gastrointestinal and joint symptoms were 28.57% and 17.14%, respectively. There was no significant difference between the two groups (Pa> 0.05). During follow-up, TWP treatment of children with blood and liver and kidney function was normal. Conclusion TWP is superior to corticosteroids in the treatment of children with HSP refractory skin purpura. TWP short-term treatment has the early role in preventing HSP renal damage, and no significant adverse reactions.