ISSN 1674-3865  CN 21-1569/R
主管:国家卫生健康委员会
主办:中国医师协会
   辽宁省基础医学研究所
   辽宁中医药大学附属医院

中国中西医结合儿科学 ›› 2017, Vol. 9 ›› Issue (5): 397-400.doi: 10.3969/j.issn.1674-3865.2017.05.010

• 临床研究 • 上一篇    下一篇

地塞米松联合丙种球蛋白治疗小儿过敏性紫癜性肾炎的疗效及对尿蛋白、尿红细胞的影响

梁群娣,张翠平   

  1. 510006 广东 惠州,惠州市第一妇幼保健院药剂科(梁群娣),儿科(张翠平)
  • 出版日期:2017-10-25 发布日期:2017-12-18
  • 通讯作者: 梁群娣,E-mail:zengfantang01@sina.com
  • 作者简介:梁群娣(1985-),女,主管药师。研究方向:小儿用药

Effect of dexamethasone combined with gamma globulin in treatment of children with Henoch Schonlein purpura nephritis and its effect on urinary protein and urine red blood cells

LIANG Qundi,ZHANG Cuiping   

  1. First Maternal and Child Health Care Hospital,Huizhou 510006,China
  • Online:2017-10-25 Published:2017-12-18

摘要:
目的
观察地塞米松联合丙种球蛋白治疗小儿过敏性紫癜(HSP)性肾炎的疗效及对尿蛋白、尿红细胞的影响。
方法
选择2014年5月至2016年5月惠州市第一妇幼保健院儿科收治的90例HSP患儿为研究对象,随机分为观察组和对照组各45例。对照组采用地塞米松进行治疗,观察组采用地塞米松联合丙种球蛋白进行治疗。4周为1个疗程。观察两组临床疗效、治疗前后凝血指标、24 h尿蛋白和尿红细胞水平及患儿不良反应情况。
结果
观察组治疗后总有效率为95.6%(43/45),显著高于对照组77.8%(35/45),差异有统计学意义(P<0.05)。治疗4周后,两组凝血酶原时间较治疗前均无明显改变,差异无统计学意义(P>0.05)|两组部分凝血活酶时间显著高于治疗前,纤维蛋白原含量显著低于治疗前,差异有统计学意义(P<0.05)|观察组治疗后部分凝血活酶时间值显著高于对照组,纤维蛋白原含量显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组患儿24 h尿蛋白、尿红细胞水平与治疗前比较均降低,差异有统计学意义(P<0.05)|观察组24 h尿蛋白、尿红细胞水平显著低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.4%(2/45),对照组不良反应发生率为6.7%(3/45),两组患儿不良反应发生率比较差异无统计学意义(P>0.05)。治疗前和治疗4周时两组患儿肾损害发生率比较差异无统计学意义(P>0.05)。治疗3个月后随访观察组失访1例,对照组肾损害发生率为28.9%(13/45),显著高于观察组11.4%(5/44),差异有统计学意义(P<0.05)。
结论
地塞米松联合丙种球蛋白治疗小儿过敏性紫癜性肾炎效果确切,能够显著降低患者尿蛋白和尿红细胞水平,改善患儿肾功能,不良反应较少,值得临床推广。

关键词: 过敏性紫癜性肾炎, 地塞米松, 丙种球蛋白, 尿蛋白, 尿红细胞, 儿童

Abstract:
Objective
To observe the curative effect of dexamethasone combined with gamma globulin in treatment of children with Henoch Schonlein purpura nephritis and its effect on urinary protein and urine red blood cells.
Methods
A total of 90 cases of allergic purpura treated in our hospital were randomly divided into observation group and control group, 45 cases in each group. The control group was given dexamethasone treatment,and observation group were treated with dexamethasone combined with gamma globulin, four weeks as a course. The clinical efficacy, blood coagulation index before and after treatment, 24h urine protein and urine red cell level and adverse reaction were observed.
Results
The total effective rate of observation group after treatment was 95.6%(43/45), significantly higher than the control group(77.8%,35/45),the difference being statistical(P<0.05). After 4 weeks of treatment, PT value of both groups had no significant change(P>0.05). APTT was significantly higher in the observation group than in the control group after treatment, while FIB was significantly lower, the difference being statistical(P<0.05). After treatment, the level of 24h urine protein and urine red blood cells was lower than before treatment, and the difference was statistical (P<0.05); the level of 24h urine protein and urine red blood cells of observation group was significantly lower than that in control group, the difference being statistical(P<0.05).The occurrence rate of adverse reaction was 4.4%(2/45) in observation group, and 6.7%(3/45) in control group, there being no difference between the two groups(P>0.05). There was no statistical difference in the occurrence rate of renal damage between the two groups before and 4 weeks after treatment(P>0.05). The follow-up after 3 months of treatment revealed that the rate of renal damage in control group was 28.9%(13/45), significantly higher than that in observation group(11.4%,5/44),in which group one case was lost of follow-up, and the difference was statistical(P<0.05).
Conclusion
The treatment with dexamethasone combined with gamma globulin has good effect on children with Henoch Schonlein purpura nephritis,which can significantly decrease the level of urine protein and red blood cells and improve the renal function; it has fewer adverse reactions and is worthy of clinical application.

Key words: Henoch Schonlein purpura nephritis, Dexamethasone, Gamma globulin, Urine protein, Urine red blood cell, Child