标题：孟鲁司特钠联合肾上腺皮质激素治疗过敏性紫癜疗效观察

      作者：张晓栋，刘彩霞，郑亚兰，解坤鹏    汉中市人民医院儿科，陕西 汉中 723000

      卷次： 2022年33卷13期

      【摘要】 目的 评价孟鲁司特钠联合肾上腺皮质激素治疗过敏性紫癜(HSP)患儿的临床效果。方法 选取2019年 4月至 2021年 3月汉中市人民医院儿科收治的 117例HSP患儿为研究对象，按随机数表法分为对照组(n=58)和观察组(n=59)。对照组予以肾上腺皮质激素治疗，观察组予以孟鲁司特钠联合肾上腺皮质激素治疗，总疗程4周。比较两组患儿的临床症状改善情况，以及治疗前后的血清炎症因子[肿瘤坏死因子α (TNF-α)、白细胞介素6 (IL-6)、白细胞介素8 (IL-8)]、免疫指标[免疫球蛋白A (IgA)及免疫球蛋白M (IgM)]水平，同时比较两组患儿的临床疗效和治疗期间的药物不良反应发生情况。结果 治疗后，观察组患儿的紫癜消失时间、关节症状缓解时间、消化道症状缓解时间、尿常规恢复正常时间分别为(8.75±1.28) d、(3.86±0.64) d、(3.61±0.67) d、(3.22±0.66) d，明显快于对照组的(12.21±1.86) d、(5.21±0.85) d、(5.14±0.98) d、(4.96±1.07) d，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的TNF-α、IL-6、IL-8水平分别为(121.75±13.96) ng/L、(88.55±9.86) ng/L、(72.04±8.33) ng/L，明显低于对照组的(140.18±16.20) ng/L、(103.46±11.62) ng/L、(88.12±10.48) ng/L，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的 IgA、IgM分别为(5.22±0.92) g/L、(1.56±0.25) g/L，明显低于对照组的(7.37±1.33) g/L、(2.13±0.37) g/L，差异均有统计学意义(P<0.05)；观察组患儿的临床治疗总有效率为93.22%，明显高于对照组的77.59%，差异有统计学意义(P<0.05)；观察组患儿治疗期间的药物不良反应总发生率为27.12%，略高于对照组的 18.97%，差异无统计学意义(P>0.05)。结论 孟鲁司特钠联合肾上腺皮质激素治疗HSP可显著改善患儿临床症状，有效抑制炎症反应和调节免疫功能，具有较好的临床治疗效果和安全性。
      【关键词】 过敏性紫癜；孟鲁司特钠；肾上腺皮质激素；疗效；安全性
      【中图分类号】 R554+.6 【文献标识码】 A 【文章编号】 1003—6350（2022）13—1702—04

Efficacy of montelukast sodium combined with adrenocortical hormone in the treatment of Henoch-Schonleinpurpura.
ZHANG Xiao-dong, LIU Cai-xia, ZHENG Ya-lan, XIE Kun-peng. Department of Pediatrics, Hanzhong People'sHospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To evaluate the clinical efficacy of montelukast sodium combined with adrenocorticalhormone in the treatment of children with allergic purpura (HSP). Methods A total of 117 children with HSP admittedto the Department of Pediatrics, Hanzhong People's Hospital from April 2019 to March 2021 were selected as the re-search objects. All patients were divided into a control group (n=58) and an observation group (n=59) by simple randomnumber table method. Patients in control group was treated with adrenocortical hormone, while those in the observationgroup were treated with montelukast sodium and adrenocortical hormone, for four weeks. The improvement of clinicalsymptoms, serum inflammatory factors [tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8)],immune indexes [Immunoglobulin A (IgA) and immunoglobulin M (IgM)] levels before and after treatment were com-pared between the two groups. At the same time, the clinical efficacy and the incidence of adverse drug reactions duringtreatment were compared between the two groups. Results After treatment, the disappearance time of purpura, jointsymptom relief time, digestive tract symptom relief time and urine routine recovery time in the observation group were(8.75±1.28) d, (3.86±0.64) d, (3.61±0.67) d, (3.22±0.66) d, which were significantly shorter than (12.21±1.86) d, (5.21±0.85) d, (5.14±0.98) d, and (4.96±1.07) d of the control group (P<0.05). After treatment, the levels of TNF-α, IL-6,and IL-8 in the observation group were (121.75±13.96) ng/L, (88.55±9.86) ng/L, (72.04±8.33) ng/L, respectively,which were significantly lower than (140.18±16.20) ng/L, (103.46±11.62) ng/L, and (88.12±10.48) ng/L of the controlgroup (P<0.05). After treatment, the levels of IgA and IgM in the observation group were (5.22±0.92) g/L and (1.56±0.25) g/L, which were significantly lower than (7.37±1.33) g/L and (2.13±0.25) g/L in the control group (P<0.05). Thetotal effective rate of clinical treatment in the observation group was 93.22% , which was significantly higher than77.59% in the control group (P<0.05). The total incidence of adverse drug reactions during treatment in the observa-tion group was 27.12%, slightly higher than 18.97% in the control group, with no statistically significant differences