摘要
目的了解我国目前血液净化治疗儿童重症系统性红斑狼疮(SLE)现状。方法中国医师协会儿科医师分会血液净化专家委员会讨论并制定调查表,以问卷调查的形式,收集2012年1月至2017年12月在参与研究的22家单位住院行血液净化治疗的127例重症SLE患儿病例资料,并进行统计学分析。结果共收集数据127例,其中男28例、女99例,年龄4~16岁,63例患儿应用血浆置换(PE)治疗180次,41例患儿应用DNA免疫吸附(DNA-IAS)治疗106次,11例患儿应用血液透析(HD)治疗112次,12例患儿应用血液灌流(HP)治疗32次。PE和DNA-IAS治疗后SLE疾病活动指数(SLEDAI)、ANA滴度、抗ds-DNA抗体、免疫球蛋白明显下降,补体回升;HD用于肾功能不全患儿治疗效果显著;HP能够清除炎症因子,使患儿临床症状缓解。PE、DNA-IAS、HD、HP的好转率分别为87.30%、87.80%、72.73%、75.00%。结论 PE和DNA-IAS疗法可迅速清除重症SLE患儿血液中的免疫性物质,缓解病情;HD治疗主要用于重度水肿及肾功能不全患儿;HP治疗能够有效清除炎症因子,缓解临床症状;对于重症SLE患儿,应根据病情的不同选择各异的血液净化疗法。
Objective To study the current status of common blood purification therapy for childhood-onset severe systemic lupus erythematosus（SLE）in China. Methods The questionnaire was discussed and set by Pediatric Blood Purification Specialist Committee;the data of 127 hospitalized children with blood purification therapy in 22 units were collected and analyzed from January 1,2012 to December 31,2017. Results（1）Among the 127 cases,including 28 males and 99 females,between 4 to 16 years old. 63 cases were treated by plasma exchange（PE）for 180 times,41 cases were treated by DNA immunoadsorption（DNA-IAS）for 106 times,11 cases were treated by hemodialysis（HD）for 112 times,12 cases were treated by hemoperfusion（HP）for 32 times.（2）PE and DNA-IAS can alleviate the clinical symptoms effectively,causing the systemic lupus erythematosus disease activity index（SLEDAI）,ANA titer,antidouble-stranded DNA antibodies,immunoglobulin to decrease and complement to increase significantly. HD for children with renal insufficiency was effective;HP can eliminate inflammatory factors and relieve clinical symptoms of children.The remission rates of PE,DNA-IAS,HD and HP were 87.30%,87.80%,72.73% and 75.00% respectively. Conclusion PE and DNA-IAS therapy can remove the immune substances in the blood of children with severe SLE quickly and relieve the disease;HD therapy is mainly used for children with severe edema and renal insufficiency;HP therapy can eliminate inflammatory factors effectively and improve clinical symptoms. For children with severe SLE,different blood purification mode should be selected according to the difference of the children＇s condition.
出处
《中国实用儿科杂志》
CSCD
北大核心
2018年第7期521-527,共7页
Chinese Journal of Practical Pediatrics
关键词
血液净化
儿童系统性红斑狼疮
流行病学
blood purification
childhood-onset systemic lupus erythematosus
epidemiology
