Abstract:

Objective The study aimed to explore the efficacy and safety of single?dose CTX intravenous pulse therapy for severe gastrointestinal involvement of Henoch Sch?nlein purpura in children. Methods A total of 256 children with abdominal Henoch?Sch?nlein purpura admitted to the Department of Pediatrics of Jingzhou Hospital affiliated to Yangtze University from January 1 in 2017 to June 1 in 2022 were divided into three groups according to the pain digital evaluation scale （NRS?11） and clinical characteristics，which were common type group （157 cases） and severe type group （99 cases）. According to the different treatment options of IVIG and CTX， the severe group was divided into IVIG group （53 cases） and CTX group （46 cases）. 50 healthy children admitted to the hospital for physical examination during the same period were selected as the control group. The changes of laboratory indicators were compared in each group， and the drug efficacy， repeated conditions， complications and adverse reactions were analyzed. Results There was no difference in all laboratory indicators between the healthy control group and the common type group （P > 0.05）. Compared with common type group， WBC， NE and CRP were significantly higher in severe group （P < 0.05）； HGB， ALB and IgG were significantly decreased （P < 0.05）； there was no difference in RDW， PLT， Cr， CystatinC， IgA， C3 and C4 （P > 0.05）. Meanwhile， there was no difference in laboratory indicators between the CTX group and the IVIG group before treatment. Resolution of abdominal pain， hemafecia， time of fasting， duration of intravenous methylprednisolone and the average hospitalization were significantly shortened （P < 0.05）； cumulative use of methylprednisolone， recurrence of abdominal pain and new rashes were significantly reduced （P < 0.05）. In addition， there were no obvious adverse reactions in CTX group， such as hemorrhagic cystitis， leukopenia or severe gastrointestinal reactions. Conclusion When the child is in a high inflammatory state and low IgG level， and it is difficult to withdraw the high dose of glucocorticoid， the early use of single?dose CTX intravenous treatment could quickly control the disease activity， reduce the amount of glucocorticoid， decrease the recurrence rate of bloody stools and abdominal pain， and have no obvious adverse reactions. The efficacy is superior to IVIG.

Key words: abdominal henoch?sch?nlein purpura, severe, cyclophosphamide sepsis, glucocorticoid, IVIG, children