摘要
目的探讨常规剂量强的松并输注浓缩血小板、大剂量静脉注射丙种球蛋白(IVIG)或大剂量甲基强的松龙(甲强龙)、或二者联合治疗重症特发性血小板减少性紫癜(ITP)的效果。方法根据病情和病人经济能力将118例次病人分为常规剂量的强的松加输注浓缩血小板组(简称血小板组)37例;用大剂量IVIG/甲强龙组(简称药物组)39例;大剂量IVIG/甲强龙联合输注浓缩血小板组(简称联合组)42例。比较3组治疗前、后血小板计数。同时观察临床出血情况。结果治疗后外周血小板计数,血小板组升高(15.40±12.14)×109/L(p<0.001),药物组升高(17.98±14.01)×109/L(p<0.001),联合组升高(43.26±13.20)×109/L,(p<0.001)。联合组高于血小板组和药物组(p<0.001)。治疗3天后临床出血改善率,血小板组60%(22/37),药物组54%(21/39),联合组90%(38/42)。5例发热病人输注浓缩血小板后外周血小板计数未见升高。结论重症ITP病人,大剂量IVIG/甲强龙联合输注浓缩血小板较单纯输注浓缩血小板或大剂量IVIG/甲强龙疗效好,手工采和机单采浓缩血小板的输注无效性的发生率尚待进一步观察。
Objective To study therapy effects of platelets concentrates （PC）transfusion and big dosage of intravenous immunoglobulin（IVIG） and methylprednisolone（MEDRON）on severe idiopathic thrombocytopenic purpura（ITP）.Methods 118 patients with severe ITP were randomly divided into three groups,one named platelets transfused group of 37 cases transfused PC and regular dosage prednisone,the other drugs group of 39 cases used big dosage of IVIG and/or MEDRON,the third combined group of 42 cases treated with PC transfusion and big dosage of IVIG or MEDRON.Blood platelets counts and clinical bleeding of three groups were compared before and after treatment. Results After therapy all blood platelets counts of three groups get higher than that before therapy, the count differences in platelets transfused group is（15.40±12.14）×10^9/L,in drugs group（17.98±14.01）×10^9/L,in combined group （43.26±13.20）×10^9/L.There are significant difference between combined group and other two groups （p〈0.001）.Three days after treatment clinical bleeding improvement percentage are 60%（22/37） in platelets transfused group,54%（21/39）in drugs group,90% （38/42）in combined group,respectively.Blood platelets counts after treatment did not increase in 5 febrile patients. Conclusion In patients with severe ITP effectiveness of PC transfusion combining with big dosage of IVIG or MEDRON are higher than that of single PC transfusion or big dosage of IVIG or MEDRON.Platelets transfusion effectivenessless rate between random PC and single donor PC are to be investigate.
