血液灌流在儿童重型皮肌炎治疗中的应用

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (2): 144-146.

血液灌流在儿童重型皮肌炎治疗中的应用

李春珍, 张东风, 刘玲, 崔洁媛, 袁晓颖, 刘福娟, 杨艳君

河北省儿童医院肾脏免疫科(河北石家庄　050031)

收稿日期:2013-09-29 出版日期:2014-02-15 发布日期:2014-02-15

The application of hemoperfusion in severe juvenile dermatomyositis　

LI Chunzhen, ZHANG Dongfeng, LIU Ling, CUI Jieyuan, YUAN Xiaoying, LIU Fujuan, YANG Yanjun

(Department of Nephrology and Rheumatism Immunity, Hebei Children's Hospital, Shijiazhang 050031, Hebei, China)

Received:2013-09-29 Online:2014-02-15 Published:2014-02-15

摘要/Abstract

摘要：

　目的　观察血液灌流治疗儿童重型皮肌炎的效果。方法　回顾性分析2例重型皮肌炎接受血液灌流治疗患儿的临床资料。结果　2例患儿血液灌流过程顺利，灌流后肌痛症状明显好转，肌酶明显下降；其中1例患儿在血液灌流后拒绝接受治疗，病情反复；另1例患儿灌流后继续给予免疫抑制剂等积极治疗，最终好转出院。结论　血液灌流可以作为重型皮肌炎的辅助治疗方法，可用于一般治疗无效者。

Abstract: 　Objectives　To investigate the clinical effect of hemoperfusion in severe juvenile dermatomyositis. Methods　Two patients with severe juvenile dermatomyositis, who accepted hemoperfusion treatment, were retrospectively analyzed. Results　In these 2 patients, the hemoperfusion process were smooth. The muscle pain was reduced and the muscle enzymes were decreased. After hemoperfusion, one patient refused to continue treatment and the disease recurrent. The other patient continued to accept the immunosuppressive therapy and eventually improved. Conclusions　For juvenile dermatomyositis, hemoperfusion was a safe and effective auxiliary treatment. It could be applied when the general treatment was invalid.

李春珍, 张东风, 刘玲, 崔洁媛, 袁晓颖, 刘福娟, 杨艳君. 血液灌流在儿童重型皮肌炎治疗中的应用[J]. 临床儿科杂志, 2014, 32(2): 144-146.

LI Chunzhen,ZHANG Dongfeng,LIU Ling,CUI Jieyuan,YUAN Xiaoying,LIU Fujuan,YANG Yanjun . The application of hemoperfusion in severe juvenile dermatomyositis　[J]. , 2014, 32(2): 144-146.

参考文献

[1] Bohan A，Peter JB. Polymyositis and dermatomyositis(first of two parts) [J]. N Engl J Med，1975，292(7)：344-347.
[2] Ernste FC，Crowson CS，de Padilla CL,et al. Longitudinal Peripheral Blood Lymphocyte Subsets Correlate with Decreased Disease Activity in Juvenile Dermatomyositis [J]. J Rheumatol，2013，40(7)：1200-1211.
[3] 吴蔚，王胜军，李遇梅，等. 皮肌炎患者外周血CD4+Th1/Th2细胞因子及转录因子的表达 [J]. 江苏医药，2008，34（9）：867-869.
[4] Oddis CV，Reed AM，Aggarwal R，et al. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis： a randomized，placebo-phase trial [J]. Arthritis Rheum，2013，65(2)：314-324.
[5] Yokoyama T，Shimizu M，Ishikawa S，et al. Accumulation of mature B cells in the inflamed muscle tissue of a patient with anti-155/140 antibody-positive juvenile dermatomyositis [J]. Mod Rheumatol，2013，23(1)：167-171.
[6] Shrestha S，Wershil B，Sarwark JF，et al. Lesional and nonlesional skin from patients with untreated juvenile dermatomyositis displays increased numbers of mast cells and mature plasmacytoid dendritic cells [J]. Arthritis Rheum，2010，62(9)：2813-2822.
[7] Kim E，Cook-Mills J，Morgan G，et al. Increased expression of vascular cell adhesion molecule 1 in muscle biopsy samples from juvenile dermatomyositis patients with short duration of untreated disease is regulated by miR-126 [J]. Arthritis Rheum，2012，64(11)：3809-3017.
[8] 李澄，刘升云，冯树芳，等. 皮肌炎患者血清中TGF-β1及GM-CSF细胞因子水平的测定 [J]. 中国免疫学杂志.2003，19（7）：509-510.
[9] Baechler EC，Bilgic H，Reed AM. Type I interferon pathway in adult and juvenile dermatomyositis [J]. Arthritis Res Ther，2011，13(6)：249.
[10] Niewold TB，Wu SC，Smith M，et al. Familial aggregation of autoimmune disease in juvenile dermatomyositis [J]. Pediatrics，2011，127(5)：e1239-e1246.
[11] Kim NN，Lio PA，Morgan GA，et al. Double trouble： therapeutic challenges in patients with both juvenile dermatomyositis and psoriasis [J]. Arch Dermatol，2011,147(7)：831-835.
[12] Chiu YE，Co DO. Juvenile dermatomyositis： immunopathogenesis，role of myositis-specific autoantibodies，and review of rituximab use [J]. Pediatr Dermatol，2011,28(4)：357-367.
[13] Bader-Meunier B，Decaluwe H，Barnerias C，et al. Safety and efficacy of rituximab in severe juvenile dermatomyositis：results from 9 patients from the French Autoimmunity and Rituximab registry [J]. J Rheumatol，2011，38(7)：1436-1440.
[14] Rosa Neto NS，Goldenstein-Schainberg C. Juvenile dermatomyositis：review and update of the pathogenesis and treatment [J]. Rev Bras Reumatol，2010，50(3)：299-312.
[15] Bustos BR，Carrasco AC，Toledo RC. Plasmapheresis for macrophage activation syndrome and multiorgan failure as first presentation of juvenile dermatomyositis [J]. An Pediatr (Barc)，2012,77(1)：47-50.
[16] 李丰，曾华松，儿童皮肌炎的诊断与治疗[J].实用儿科临床杂志，2012，27（21）：1694-1696.