›› 2015, Vol. 33 ›› Issue (4): 352-.doi: 10.3969 j.issn.1000-3606.2015.04.016

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Treatment timing and method of glucocorticoids in abdominal type Henoch-Schönlein purpura

 SHI Xuewen, CHEN Juan, YIN Mingdong, CHEN Xiangqian, CAO Qing   

  1. Department of Nephrology, Sihong Children’s Hospital, Sihong 223900, Jiangsu, China
  • Received:2015-04-15 Online:2015-04-15 Published:2015-04-15

Abstract: Objectives To study the treatment timing and method of glucocorticoids in the treatment of abdominal type Henoch-Schönlein purpura (HSP). Methods A total of 201 children with abdominal type HSP hospitalized from September 2009 to April 2013 received either conventional glucocorticoids treatment or rapid titration treatment of glucocorticoids based on the same basic therapy. According to the treatment timing and method of glucocorticoids, all patients were divided into 4 groups including early convention group (n=46), late convention group (n=44), early titration group (n=56) and late titration group (n=55). The duration from the appearance of gastrointestinal symptoms to using glucocorticoids less than or equal to three days was defined as early treatment and more than three days was defined as late treatment. The patients in two convention groups (early and late) were treated with methylprednisolone (2-6mg/kg per day).The patients in two titration groups (early and late) received rapid titration of methylprednisolone from an initial low dose of 2mg/kg per day to the final target dose. The gastrointestinal symptoms were evaluated every 12 hours. If the gastrointestinal symptoms were not alleviated, an additional dosage of methylprednisolone was given. On the next day, the total dose of methylprednisolone in previous 24 hours was used as the initial dose. The dosage was increased in such a way till the gastrointestinal symptoms disappeared and this dosage was remained for 3 days. Then the dosage was gradually reduced to the maintenance dose and stopped. If the gastrointestinal symptoms were relapsed, the patients were treated again. A follow-up of 3-6 months was performed. The dosage, recurrence of symptoms and the side effects were compared among four groups. Results The time of remission, target dose of glucocorticoids, total dose of glucocorticoids, recurrence rate, incidence of severe symptoms and Henoch-Schonlein purpura nephritis were significantly different among four groups (P<0.05). The curative effect was best in early titration group and worst in late convention group. Conclusions In the treatment of abdominal type HSP, early titration treatment with glucocorticoids can significantly relieve the gastrointestinal symptoms and reduce the total dosage of glucocorticoids.