摘要
目的:总结过敏性紫癜(HSP)湿毒内蕴证患儿病情复发的临床特点,观察清热利湿、活血解毒中药对本病的疗效,探讨常见临床症状、血清25-羟维生素D_3等实验室指标及中药治疗对复发的影响。方法:收集2019年11月—2020年5月由首都医科大学附属北京儿童医院收治的初发HSP患儿,且中医辨证为湿毒内蕴证,总结其临床特点。随机将患儿分为实验组和对照组,对照组给予常规西医治疗,实验组除常规西医治疗外,给予清热利湿、活血解毒口服中药,两组疗程均为2周,对比两组患儿疗效。以患儿入院接受治疗时间为起点,在发病后第2、3、4、6个月进行门诊或电话随访,根据HSP复发判断标准判定患儿是否复发。对患儿临床各因素进行Kaplan-Meier单因素分析及Cox多因素回归分析,寻找可能与复发相关的危险因素。结果:共收集病例88例,实验组及对照组各44例。发病时主要临床表现为紫癜皮疹(88例)、腹痛(83例)、消化道出血(11例)及关节炎(11例),应用糖皮质激素治疗者80例。经治疗,实验组总有效率为86.4%(38/44),高于对照组59.1%(26/44),疗效差异有统计学意义(P=0.008)。随访6个月,实验组复发率13.6%(6/44),低于对照组复发率38.6%(17/44),复发率差异有统计学意义(P=0.014)。Kaplan-Meier单因素分析显示,未口服中药治疗、病史≥2周、初发时无关节肿痛、缓解期25-羟维生素D_3缺乏,缓解期25-羟维生素D_3水平较急性期降低为HSP复发的独立危险因素(P<0.05)。Cox回归分析显示,未口服中药治疗、初发无关节肿痛、治疗期间无腹痛反复、缓解期25-羟维生素D_3水平较急性期下降、过敏原阳性为HSP复发危险因素。结论:应用清热利湿、活血解毒中药治疗HSP湿毒内蕴证,能起到改善疗效,预防复发的作用。对于病史较长、病初无关节肿痛、腹痛无反复、缓解期25-羟维生素D_3水平较急性期下降、过敏原阳性的初发HSP患儿,应积极随访,警惕其复发可能。
Objective:To summarize the clinical characteristics of the recurrence in pediatric patients with henoch-schonlein purpura(HSP)of dampness-toxic syndrome,to observe the effect of herbs of clearing heat and promoting diuresis,activating blood and removing toxin in treating HSP,and to explore the influence of common clinical symptoms,serum 25-hydroxyvitamin D3 and TCM medication on disease recurrence.Methods:The primary cases with HSP,which were diagnosed as the syndrome of damp-toxin retention,were collected to analyze the clinical characteristic.The children patients were randomly divided into the study group and the control group.The control group was treated with conventional western medication;on which basis,the study group was also treated with herbs of clearing heat and promoting diuresis,activating blood and removing toxin.The treatment course of both groups was 2 weeks,and the efficacy was compared between the two groups.Starting from the time of admission and treatment,the patients were followed up 2,3,4 and 6 months after the onset of the disease.The recurrence was evaluated according to the criteria for judging the recurrence of HSP.Kaplan-meier univariate analysis and Cox multivariate regression analysis were performed on the clinical characteristics of the children to search for risk factors that might be related to disease recurrence.Results:A total of 88 cases were collected,including 44 cases in the study group and 44 cases in the control group.The main clinical manifestations at the onset were purpura(88 cases),abdominal pain(83 cases),gastrointestinal bleeding(11 cases)and arthritis(11 cases).Glucocorticoid therapy was applied in 80 cases.After the treatment,the total effective rate of the study group was 86.4%(38/44),which was significantly higher than 59.1%(26/44)of the control group(P=0.008).After a 6-month follow-up,the recurrence rate was 13.6%(6/44)in the study group,which was lower than 38.6%(17/44)in the control group(P=0.014).Kaplan-meier univariate analysis showed that the independent risk factors for HSP recurrence were the absence of oral Chinese medicine,a history of more than 2 weeks,the absence of joint swelling or pain at the initial onset,the deficiency of 25-hydroxyvitamin D3 at the remission stage,as well as the decrease of 25-hydroxyvitamin D3 level in the remission period compared to that in the acute period(P<0.05).Cox regression analysis showed that the risk factors of HSP recurrence were the absence of oral Chinese medicine,the absence of joint swelling and pain in the initial onset,the absence of recurrent abdominal pain during the treatment,the decrease of 25-hydroxyvitamin D3 level in the remission period compared to that in the acute period,as well as the positive allergen.Conclusion:The application of herbs of clearing heat and promoting diuresis,activating blood and removing toxin can improve efficacy and prevent recurrence in the treatment of HSP with retention of damp-toxin.For the children patients with HSP,who have a long medical history,no joint swelling and pain at the onset of the disease,the absence of recurrent abdominal pain during the treatment,decreased 25-hydroxyvitamin D3 level at the remission stage compared to that in the acute stage,and for those who have positive allergen,should be actively followed up to prevent the recurrence.
作者
何松蔚
王俊宏
赵骞
杨燕
HE Songwei;WANG Junhong;ZHAO Qian;YANG Yan(National Center for Children’s Health,Beijing Children’s Hospital,Capital Medical University,Beijing 100045,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)
出处
《中医药学报》
CAS
2021年第4期47-53,共7页
Acta Chinese Medicine and Pharmacology
基金
国家中医药管理局第六批全国老中医药专家学术经验继承项目(国中医药人教发[2017]29号)
北京市自然科学基金资助项目(7172076)
北京中医药科技发展资金(JJ2018-45)。
关键词
过敏性紫癜
湿毒内蕴证
复发
25-羟维生素D_3
中药治疗
Henoch-schonlein purpura
Dampness-toxic syndrome
Recurrence
25-hydroxyvitamin D3
TCM medication
