从痈论治腹型过敏性紫癜患儿的疗效观察

赵骞 闫慧敏 郝静 何强 刘畅 王昕泰

摘要 目的：观察并评价从痈论治腹型过敏性紫癜患儿的临床疗效。方法：选取2017年1月至2020年6月首都医科大学附属北京儿童医院收治的过敏性紫癜（腹型）患儿100例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组50例。2组均给予激素等常规西药治疗，观察组在西药治疗基础上给予口服解毒消痈止痛方，疗程为2周。比较2组患儿疗效、症状缓解时间及治疗前后C反应蛋白（CRP）、红细胞沉降率（ESR）及白细胞计数（WBC）、D-二聚体变化，并随访2组患儿复发情况。结果：观察组在治疗有效率、治疗后症状缓解时间及治疗后CRP、D-二聚体水平的改善优于对照组（P<0.05），治疗后随访6个月，观察组复发率低于对照组（P<0.05）。結论：在常规西药治疗基础上联合应用从痈论治理论指导下的凉血消痈止痛中药治疗腹型过敏性紫癜患儿，较单纯西药治疗，在改善症状、缩短病程、减少复发方面具有一定优势，可进一步提高治疗效果。

关键词 腹型过敏性紫癜;从痈论治;内痈;胃镜

Abstract Objective：To observe and evaluate the clinical effect of treating children with abdominal type Henoch Schonlein purpura from carbuncle.Methods：A total of 100 children with allergic purpura（abdominal type） admitted to Beijing Children′s Hospital Affiliated to Capital Medical University were selected as the research objects and were randomly divided into a treatment group（n=50） and a control group（n=50）.Both groups were treated with hormone and other conventional Western medicine for 2 weeks.The observation group was treated with oral Liangxue Xiaoyong Zhitong Decoction on the basis of Western medicine for 2 weeks.The curative effects，symptom remission time，changes in C-reactive protein（CRP），erythrocyte sedimentation rate（ESR），white blood cell count（WBC），D-dimer before and after treatment，and the recurrence of the 2 groups were followed up.Results：The total effective rate，symptom pain relief time，CRP and D-dimer levels in the treatment group were better than those in the control group（P<0.05）.After 6 months of follow-up，the recurrence rate of the treatment group was lower than that of the control group（P<0.05）.Conclusion：On the basis of conventional Western medicine treatment，the Chinese medicine for cooling blood，eliminating carbuncle and analgesic under the guidance of the theory of carbuncle therapy is combined to treat children with abdominal allergic purpura.Compared with Western medicine treatment，it has certain advantages in improving symptoms，shortening the course of disease，and reducing recurrence，and can further improve the treatment effect.

Keywords Abdominal anaphylactoid purpura; Treatment from carbuncle; Internal carbuncle; Gastroscope

中图分类号：R242;R751文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.019

过敏性紫癜（Henoch-Schonlein Purpura，HSP）是儿童时期最常见的血管炎之一，其病理表现为累及毛细血管及细小动脉的白细胞碎裂性血管炎[1]。近三分之二的HSP患者可累及胃肠道[2]，即腹型过敏性紫癜，出现腹痛、呕吐、便血、呕血等胃肠道症状，严重者可继发肠梗阻、肠套叠、肠穿孔等[3]。是儿科临床中的急重症。目前西医治疗本病主要采用对症治疗，严重者应用激素等免疫抑制剂。研究表明，中西医结合治疗本病具有一定的优势[4-6]。我们在长期诊治过敏性紫癜患儿的过程中，开发了青紫合剂、青紫止痛方等代表方药[4，7-9]，治疗思路以清热利湿，凉血祛瘀为主，闫慧敏教授在其基础上，经过临床实践，结合腹型HSP患儿胃镜下表现为胃十二指肠黏膜充血水肿、出血、糜烂、溃疡的特点，认为其具有中医“痈”红、肿、热、痛的特点，可归入“内痈”范畴，从痈论治，针对本病急性期以湿毒内蕴证为主，创立了解毒消痈止痛方。……