重症免疫性血小板减少性紫癜紧急救治方案的探讨

为了探讨重症免疫性血小板减少性紫癜(ITP)的治疗方案,回顾性分析118例接受激素(92例)或丙种球蛋白(16例)或rhTPO(10例)治疗患者的临床资料,分析疗效及不良反应。结果显示:(1)激素组、丙种球蛋白组和rhTPO组总有效率分别为76.1%、81.3%和70%,组间差异无统计学意义。复发组有效率(67.3%)明显低于初治组(83.3%,P0.05),PAIgG伴PAIgM升高组有效率明显低于不伴PAIgM升高组(P0.05);(2)血小板达峰时间:激素组为(5.70±3.68)d,丙种球蛋白组为(4.31±0.75)d,rhTPO组为(5.00±1.63)d,激素组与丙种球蛋白组间差异有统计学意义(P0.05);(3)不良反应:激素组均出现类库欣综合征表现,丙种球蛋白组未见不良反应,1例(10%)rhTPO组患者出现轻度转氨酶增高。总之,丙种球蛋白和rhTPO治疗成人重症ITP疗效好,不良反应轻微。

Treatment for Serious Immune Thrombocytopenic Purpura

To investigate therapeutic schedules in the emergency treatment of serious immune thrombocytopenic purpura（ITP）, retrospective analysis of 118 cases with serious ITP treated with glucocorticoids （92cases） or immunoglobulin （ 16 cases） or rhTPO （10 cases） were performed. The results indicated that the total effective rate of glucocorticoids group, imrnunoglobulin group and rhTPO group was 76.1 %, 81.3 % and 70% respectively. No significant differences were found between each two groups. Compared with relapsed patients, the effect of primary diagnosed cases was significantly higher （83.3 % vs. 67.3 %,P〈0.05）. Furthermore, patients with increased level of PAIgG and PAIgM simultaneously had poo- rer treatment response than that in cases with single increased PAIgG （P〈0.05）. The blood platelet count in immuno- globulin group reached the peak time fastest （4.31 ±0. 75 days）, followed by rhTPO group {5.00±1.63 days） and the glucocorticoids group （5.70±3.68 days） ,and the difference between immunoglobulin and glucocorticoids group was statistically significant （P〈0.05 ）. As to the side effects related to treatments, all of cases in glucocorticoids group presented more or less Cushing Syndrome--like clinical signs, one patient treated with rhTPO showed slightly elevation in transaminase, while no side effects were observed in immunoglobulin group. In conclusion, immunoglobulin and rhTPO have satisfactory effect in the emergency treatment of serious adult ITP with minor side effects.