诊疗决策论著医学与哲学(临床决策论坛版)2010年1月第31卷第1期总第397期48MedicineandPhilosophy(ClinicalDecisionMakingForumEdition),Jan2010,Vol.31,No.1,TotalNo.397重症免疫性血小板减少性紫癜紧急救治方案的探讨王静¹孙慧¹*马杰¹摘要: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%,P<0.05),PAIgG伴PAIgM升高组有效率明显低于不伴PAIgM升高组(P<0.05);(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(P<0.05);(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。关键词:紫癜,血小板减少性,免疫性,治疗中图分类号:R554.6文献标识码:A文章编号:1002-0772(2010)01-0048-03TreatmentforSeriousImmuneThrombocytopenicPurpuraWANGJing,SUNHui,MAJie.TheFirstAffiliatedHos-pitalofZhengzhouUniversity,HenanKey-DisciplineslaboratoryClinical-Medicine,Zhengzhou450052,ChinaAbstract:Toinvestigatetherapeuticschedulesintheemergencytreatmentofseriousimmunethrombocytopenicpurpura(ITP),retrospectiveanalysisof118caseswithseriousITPtreatedwithglucocorticoids(92cases)orimmunoglobulin(16cases)orrhTPO(10cases)wereperformed.Theresultsindicatedthatthetotaleffectiverateofglucocorticoidsgroup,immunoglobulingroupandrhTPOgroupwas76.1%,81.3%and70%respectively.Nosignificantdifferenceswerefoundbetweeneachtwogroups.Comparedwithrelapsedpatients,theeffectofprimarydiagnosedcaseswassignificantlyhigher(83.3%vs.67.3%,P<0.05).Furthermore,patientswithincreasedlevelofPAIgGandPAIgMsimultaneouslyhadpoo-rertreatmentresponsethanthatincaseswithsingleincreasedPAIgG(P<0.05).Thebloodplateletcountinimmuno-globulingroupreachedthepeaktimefastest(4.31?0.75days),followedbyrhTPOgroup(5.00?1.63days)andtheglucocorticoidsgroup(5.70?3.68days),andthedifferencebetweenimmunoglobulinandglucocorticoidsgroupwasstatis-ticallysignificant(P<0.05).Astothesideeffectsrelatedtotreatments,allofcasesinglucocorticoidsgrouppresentedmoreorlessCushingSyndrome-likeclinicalsigns,onepatienttreatedwithrhTPOshowedslightlyelevationintransam-inase,whilenosideeffectswereobservedinimmunoglobulingroup.Inconclusion,immunoglobulinandrhTPOhavesatis-factoryeffectintheemergencytreatmentofseriousadultITPwithminorsideeffects.KeyWords:purpura,thrombocytopenic,immune,treatment免疫性血小板减少性紫癜(ITP)为临床常见的出血性疾病,成人多表现为慢性病程。当岀现严重或多部位岀血,或血小板计数低于20@109/L有脑出血的危险时,需要在短时间内提升血小板,减少出血风险。现对本院2007年1月至2009年6月收治的118例重症ITP病例进行回顾性分析,观察临床常用的三种紧急治疗方案的疗效与不良反应,探讨如何根据病情选择方案,报告如下。1资料和方法1.1一般资料所有病例根据参考文献[1]确诊。初治66例,复发52例;男48例,女70例,男:女1:1.5,年龄14岁~85岁,中位年龄28岁。入院时血小板计数(0~44)@109/L,中位值6@109/L。骨髓检查108例,巨核细胞数(0~1369)个/片,中位值为147个/片。多伴成熟障碍,以颗粒型巨核细胞为主。脾厚2例,曾接受¹郑州大学第一附属医院/河南省高等学校临床医学重点学科开放实验室河南郑州450052脾切除术5例。1.2治疗方法三种不同治疗方法分组,A组:92例为单用肾上腺皮质激素,初治56例,复发36例,静脉滴注地塞米松10mg/(m2#d)~15mg/(m2#d),5天~7天后改服强的松1mg/(...
