| ObjectiveHenoch-Schonlein purpura (HSP) is a systemic vascular inflammatorydisease, can affect multiple systems, varying severity. Glucocorticoid (GC) has beenwidely used in the joints, gastrointestinal tract and kidneys significant involvementwith HSP. Less systemic observation about the side effects of glucocorticoid therapyin children with HSP reported clinically, as the basis for further observation of thesafety and efficacy of glucocorticoid and to provide for the proper applicationtreatment in children with HSP, this study has a systematic observation and follow-upfor50patients with varying severity in children with HSP on the efficacy and sideeffects with the treatment of hydrocortisone sodium succinate (HCSS) andmethylprednisolone (MP).Methods1. Object and grouping:50cases in children with HSP hospitalized in our hospital from November2011to December2012were selected. According to the disease severity,50patients weredivided into two groups. The HCSS treatment group with30patients (the ordinarycases with heavier rashes, accompanied by abdominal pain or joint swelling) and theMP treatment group with20patients (the severe cases with gastrointestinal bleedingor severe kidney involvement).2. Research methods:(1) follow-up methods: We established a special disease follow-up file for all the children at the time of admission, detailed records of clinical data, had aclinic follow-up visit after discharge, recorded the efficacy and side effects ofdrug observations.(2) Outcome measures: Efficacy indicators: rash, joint, gastrointestinalsymptoms control time, abnormal urine clearance time and renal function;toxicity indicators: The children height and body mass index (BMI value), bloodpressure, blood (blood leukocyte count, red blood cell count, platelet count) andliver function (transaminases, bilirubin), renal function (serum creatinine, bloodurea nitrogen), the skeletal system (calcium, phosphorus, alkaline phosphatase)and heart (cardiac enzymes, heart rate, ECG) dynamic changes beforglucocorticoid treatment, during the treatment and after the treatment.(3) treatment methods: HCSS group was treated with hydrocortisone sodiumsuccinate infusion daily4to8mg/kg,3to7days according to symptomcontrol; MP group was treated with methylprednisolone infusion5to15mg/kgdaily or every other day,3to6times according to symptom control; afterinfusion therapy two groups were converted to oral prednisone with thesupplement of anticoagulant, anti-allergy and symptomatic and supportivetreatment.Results1. Efficacy:All children with skin rashes, joint and gastrointestinal symptoms were completelycontrolled within3months of treatment. The urine examinations of13cases of14patients (92.9%) with renal involvement return to normal with glucocorticoidtreatment in4weeks. The urine examination is still with protein of1patients in MPgroup with glucocorticoid treatment for4weeks, but it to be normal in the course of8weeks when combined with tripterygium. As of publication,50cases of childrenwith the disease are in complete remission, urine analysis without exception. Follow-up time:4-16months.2.side effects:①BMI values: BMI values of all children with glucocorticoid treatment weresignificantly higher than before treatment, but compared with before treatment thetwo groups showed no significant difference after stopping drug (P>0.05); Therewas no significant difference about the BMI values between MP group and HCSSgroup (P>0.05).②blood: The blood WBC and PLT value of1patient in MP group is higher thannormal after glucocorticoid treatment, The blood WBC and PLT value of two casesin HCSS group is higher than normal after glucocorticoid treatment. The WBCmean value of the two groups is higher than the normal before glucocorticoidtreatment, but back to normal during the treatment and after stopping drug, there issignificant difference compared with the before treatment (P <0.05). The bloodRBC and PLT value of the two groups have no significant change before and afterthe medication.③The renal function: Compared with before the treatment the serum creatininevalue of group MP patients increased significantly during the course of medicationand after stopping drug (P <0.05), but the serum creatinine values of all thepatients were in the normal range, blood urea nitrogen values were in the normalrange too.④the heart: in each group,2patients had a faster heart rate, but the mean heartrate values during the course of medication and after the treatment showed nosignificant changes compared with before the treatment (P>0.05); during thetreatment,1patient of each group appeared ECG abnormal, their ECG returned tonormal after stopping drug; myocardial enzymes were within the normal range.⑤The others: the liver function, blood calcium and phosphorus, alkalinephosphatase of two groups during the course of medication and after stopping drug had no significant changes compared with before treatment; the blood pressure ofall the children were normal.Conclusion1. The curative effect observation results in our study show that hydrocortisonesodium succinate in the treatment of common cases with HSP andmethylprednisolone in the treatment of severe cases with HSP both have goodshort-term effect, long-term effect needs further observation.2. The side effects observation results showed that in the treatment of HSP bothmethylprednisolone and hydrocortisone sodium succinate can cause children withhigh BMI value, but it can be resumed after stopping drug, and there is nosignificant difference between the two groups. The two kinds of glucocorticoidcan occasionally increase heart rate, make the WBC value higher, or cause theECG abnormal, but the damage degree is light and it can recover fast aftersymptomatic treatment. The two kinds of glucocorticoids have no obvious effecton the liver and kidney function, blood pressure and bone system. |
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