激素治疗无效的特发性血小板减少性紫癜的治疗方法探讨VIP专享VIP免费

鱼焦曼些堂堂!!!!笙筮!i鲞筮!翅激素治疗无效的特发性血小板减少性紫癜的治疗方法探讨△刘凌1，冯莹1，庞缨1，叶絮1，蔡晓东1，潘学谊2。陈安薇3，谭获4，毛平5(1．广州医学院第二附属医院，广州510260，2．广东药学院第一附属医院。3．广州医学院第三附属医院，4．广州医学院第二_附属医院，5．广州市第一人民医院)摘要：目的回顾性分析比较脾切除术和免疫抑制剂分别对肾上腺糖皮质激素治疗不敏感或激素依赖的特发性血小板减少性紫癜(ITP)患者的疗效，以探讨适宜的二线治疗方案。方法收集广州市5家三级甲等医院，1997～2007年近10年间住院的所有诊断为ITP且对激素治疗无效的患者共52例，对其临床资料进行分析。根据不同的治疗方案将其分为2组，A组20例为脾切除组，B组32例为使用免疫抑制剂组(包括环孢菌素A、硫唑嘌呤、长春新碱，环磷酰胺)。分别比较两组患者在治疗前、治疗后第3天、7天、1月、6月、24月时的血小板计数(BPC)及治疗副作用。结果A组患者从治疗第3天起至24个月BPC均高于B组，差异有显著性(P<0．05)。A组的总有效率高于B组，差异有显著性(P<0．05)。A组治疗副作用包括术中出血、伤口愈合不良、脾切后继发感染等，发生率为15．0％；B组治疗不良反应包括感染、骨髓抑制、肝损害、肾损害、出血性膀胱炎、末梢性周围神经炎及其他等，发生率为45．0％。其中4例免疫抑制剂治疗无效的患者行脾切除后仍能达到有效。个别切脾后疗效不佳者仅需小剂量激素和(或)联用免疫抑制剂维持。结论对激素治疗不敏感或激素依赖的ITP患者，脾切除治疗起效时间快，效果好，副作用少，可作为激素治疗失败或不能耐受者的首选二线治疗方法。关键词：特发性血小板减少性紫癜；脾切除；免疫抑制剂；疗效；副作用[中图分类号]R558．2[文献标志码]A[文章编号]1009—6213(2009)01—013—04TheTreatmentApproachtoIdiopathicThrombocytopenicPurpuraUnresponsivetoCorticosteroidTherapy1．LIULing，FENGYing，PANGYing，YEXu，CAIXiao—dong，PANXue—yi，CHENAn—wei，TAN—Huo，MAOPing(DepartmentofHematology，theSecondAffiliatedHospitalofGuangzhouMedicalCollege，Guangzhou510260，China)Abstract：ObjectiveToretrospectivelyanalyzeandcomparetheeffectofsplenectomywiththatofim—munosuppressivetherapyinpatientswithidiopathicthrombocytopenicpurpura(ITP)unresponsivetoeortico—steroidtherapy．Method52caseswithdiagnosedITPwhowerehospitalizedin5municipalcomprehensivehospitalsinGuangzhouduringtheyear1997to2007anddidnotrespondtocorticosteroidtherapywerecol—lectedandtheclinicaldatawereanalyzed．Basedontheirdifferenttreatmentregimens，thepatientsweredi—videdintosplenectomygroup(n=20)andimmunosuppressivegroup(n=32)．Patientsintheimmunosup—pressivegroupweretreatedwithcyclosporineA，azathioprine，vincristinorcyclophosphamide．Theplateletcountsbeforethetreatmentandrespectively3days，7days，onemonths，6monthsor24monthsafterthetreatmenttogetherwithtreatment—associatesideeffectswerecomparedbetweenthetwogroups．ResultsTheplateletcountsofsplenectomygroupwerehigherthanthoseofimmunosuppressivegroupfromthe3rddaytothe24monthsaftertreatmentandthedifferencewassignificant(P<0．05)．Thetotaleffectiverateofsple—nectomygroupwassignificantlyhigherthanthatofimmunosuppressiVegroup(P<0．05)．Theincidencerateofsideeffectsinsplenectomygroupwas15．O％andthatintheimmunosuppressivegroupwas45．0％．Be—sides，4easesrefractorytoimmunosuppressivetherapywerestillresponsivetosplenectomy．Veryfewcaseswhowererefractorytosplenectomycouldbemaintainedwithsmalldosesofcorticosteroidorcombinationofimmunosuppressivereagents．ConclusionSplenectomytakeseffectsearly，resultsingoodcurativeeffectsandfewersideef％ctsinpatientswithITPrefractorytocorticosteroids．Sosplenectomymaybeusedasthefirstchoic...