A Prospective Randomized Controlled Clinical Study Of Hemoperfusion In The Treatment Of Severe Allergic Purpura

Objective:Henoch-Schonlein purpura(HSP)is an IgA mediated multisystemic vasculitis that is more common in children.Although the course of disease is self-limited,it is not treated during acute vascular inflammation in severe children.Timely,there may be necrotizing rash,systemic angioedema,severe abdominal pain,gastrointestinal bleeding,intussusception,joint swelling and limited activity,renal failure,DIC and other critical symptoms,and even life-threatening.Although drug therapy can inhibit the production of inflammatory mediators,during the peak period when a large number of inflammatory mediators form during the "immune storm"period in children with severe HSP,the effect of drug treatment is significantly poor and cannot prevent disease progression.Hemoperfusion can quickly eliminate the inflammatory mediators in the blood of children with HSP,regulate the body's immune disorders,and quickly relieve the condition of children with severe HSP.This article compares the clinical effects of hemoperfusion techniques,gamma globulin,and glucocorticoids in patients with severe anaphylactoid purpura,and conducts prospective randomized controlled clinical studies of hemoperfusion treatment of severe HSP.Efficacy and reduction of the incidence of purpura nephritis were evaluated to assist in the development of standardized treatment protocols and clinical application guidelines for hemoperfusion techniques for the treatment of severe HSP.Methods:The 64 children with severe HSP diagnosed in Department of Nephrology at Nanjing Children's Hospital from October 2015 to December 2017 were randomly divided into three groups:conventional group,hemoperfusion group,and gamma globulin group.Hormone therapy was used in the conventional group,hemoperfusion was added to the hemoperfusion group on the basis of the conventional group therapy,and gamma globulin was given on the basis of the conventional group in the gamma globulin group.Observed indicators include sex,age at onset,clinical symptoms at onset,hematuria and proteinuria,treatment effect,hospital stay,rash remission,gastrointestinal relief,joint swelling and pain relief,urine microalbumin,and kidney Injury index(creatinine,cystatin,retinol binding protein),inflammatory index(CRP),coagulation system index(PLT,APTT,FIB),blood immunoglobulin(IgA)and complement(C4/C 8)levels,kidney damage,incidence of purpura nephritis,and prognosis follow-up data.Results:After the treatment in the hemoperfusion group,15 patients were markedly effective,6 patients were effective,and the total effective rate was 100.00%.After treatment with gamma globulin group,15 patients were markedly effective,8 patients were effective,and the total effective rate was 95.83%;7 cases were markedly effective,7 cases were effective,and the total effective rate was 73.68%.The therapeutic effects of the hemoperfusion group and gamma globulin group were superior to those of the routine group.The difference was statistically significant(P<0.05).The time of rash elapsing,the time of relief of digestive tract symptoms,and the time of symptom remission of joint swelling and pain were all significantly better than that of the routine group.The difference was statistically significant(P<0.05).In addition,hemoperfusion group relieves rash faster than gamma globulin group with a more significant effect(P<0.05).Before treatment,the indexes of IgA,CD4/CD8,retinol binding protein in hemoperfusion group were:(2.98±0.98),(1.05±0.28),(44.57±20.54);these indexes after treatment were:(1.73±0.64),(1.53±0.43),(21.81±8.13);the indexes of IgA,CD4/CD8,retinol binding protein in gamma globulin group were:(1.81±0.54),(1.23±0.44),(39.64±16.30).These indexes after treatment were:(1.54±0.49),(1.09±0.41),(26.52±8.78).The indexes of IgA,CD4/CD8,retinol binding protein in conventional group before treatment were:(2.30±0.21),(0.99±0.28),(42.69±12.61),and after treatment,they were(2.09±0.14),(1.09±0.52),(35.37±11.66).These above Laboratory indicators of hemoperfusion group improved more significantly than gamma globulin group and conventional group(P<0.05).After 6 months of treatment,the number of cases of secondary renal injury in the hemoperfusion group(n=0)was significantly reduced compared with the conventional group(n=5),with a significant difference(P<0.05).Conclusions:The application of hemoperfusion combined with drug therapy can quickly adsorb inflammatory mediators in severe HSP children and restore immune stability.The clinical effect of the treatment of children with severe HSP is outstanding.It can effectively relieve gastrointestinal symptoms,joint swelling and pain symptoms,promote skin rash subsidence,reduce secondary damage of renal function,and long-term therapeutic effect is good.In addition,it has a certain preventive effect on the incidence of purpura nephritis.After the technology is mature and the norms are formed,it is worthy of clinical promotion and application.It can be used as a method to rescue severe children.The application of hemoperfusion to treat severe Henoch-Schonlein purpura in children has prominent clinical effects.It can effectively reduce symptoms of digestive tract,relieve joint swelling and pain,promote skin rash subsidence,decrease secondary damage of renal function,and long-term treatment is effective.Hemoperfusion has a certain preventive effect on the development of Henoch-Schonlein purpura nephritis,and it is worthy of clinical application after the technology is mature and standardized.