血小板减少性紫癜230例临床分析

Clinical Analysis of 230 Cases With Thrombocytopenic Purpura

目的：探讨血小板减少性紫癜的病因,ITP的临床特征和治疗效果,为血小板减少性紫癜的诊断和治疗提供参考。方法：回顾性分析230例血小板减少性紫癜(包括192例ITP、17例Evans综合征和21例继发性血小板减少性紫癜)患者的临床资料。结果：192例ITP患者中有明确发病诱因者45例(23．3%),以呼吸道感染和病毒感染为主；102例ITP患者中66例(占64．7%)抗体阳性(ANA34例,抗SSA 17例,抗SSB 3例,抗SCL-70 1例,IgG升高11例),13例关节受累患者中10例风湿抗体阳性,血小板计数与糖皮质激素治疗有效率之间无相关性；4例初诊ITP患者在随访过程中被证实为继发性血小板减少性紫癜(胃癌1例,化脓性扁桃体炎1例,结缔组织病2例)。结论：应积极寻找并去除血小板减少性紫癜的病因及诱因,注意排除结缔组织病、肿瘤等引起的继发性血小板减少症。

Objective： To investigate the causes of thrombocytopenic purpura, the clinical characteristics and therapeutic effect of idiopathic thrombocytopenic purpura （ITP）. Methods：Clinical data of 230 cases with thrombocytopenic purpura （192 cases with ITP, 17 cases with Evans＇s Syndrome and 21 cases with secondary thrombocytopenic purpura） were analyzed retrospectively. Results; Among 192 cases with ITP, 45 cases（23. 3%） resulted from definite causes, respiratory tract infection and viral infection were most common. Antibodies were positive in 66 cases （64. 7%） among 102 cases with ITP. Rheumatic auto-antibodies were positive in 10 cases among 13 cases with joint pain. There was no relevance between the blood platelet count and glucocortical therapy. Four cases initially diagnosed as ITP were confirmed secondary thrombocytopenic purpura during follow-up （1 case with stomach carcinoma, 1 case with suppurative tonsillitis and 2 cases with connective tissue diseases）. Conclusion： It is important to look for and eradicate the etiological and causative factors of ITP and eliminate the secondary thrombocytopenic purpura which was ususally caused by connective tissue diasease and carcinoma.