特发性血小板减少性紫癜103例患者的临床分析

A clinical study of 103 idiopathic thrombocytopenic purpura

目的探讨特发性血小板减少性紫癜（ITP）患者发病的年龄分布、治疗反应及影响因素等。方法回顾性总结我院1992年7月-2006年12月收治的ITP患者的住院及门诊资料。结果Ⅱ＇P103例中，随访时间为2个月～15年，男：女=35：68；I〉60岁发病患者34．O％（35／103）；所有患者中，激素敏感型为57．3％（59／103），多以完全或部分反应健康存活；脾切除6例，栓塞1例，栓塞者无效，随访到的5例切脾者4例血小板一直正常；免疫抑制剂中，环孢素A效果较好，联合激素时其有效率为81．3％（26／32）。发展为干燥综合征2例，红斑狼疮1例，淋巴瘤1例。103例中死亡7例，仅1例为脑出血（30岁），其余2例死于脑血栓／梗死，2例死于非血液肿瘤，1例死于肾病，1例死于淋巴瘤。ITP患者中难治率为17．2％（10／58）。结论ITP发病有随年龄增长而升高的趋势，临床表现各异。致命性出血少，联合免疫治疗宜个体化。

Objective To investigate the prevalence by age, response to different therapies and outcome in newly diagnosed idiopathic thrombocytopenic purpura （ITP） . Methods ITP patients who were hospitalized from July 1992 to December 2006 and followed up with telephone were retrospectively analyzed. Results 103 patients with ITP were investigated. The time of follow-up was between 2 months to 15years. Male： female = 35： 68. The rate of patients over 60 years old was 34.0% （ 35/103 ）. 59 patients were sensitive to adrenocorticosteroid and 4 patients under going splenectomy achieved a normal platelet count. In those immunosuppressive agents ： including vincrisfine, cyclophosphamide, azathioprine and cyclosporin A （CsA） used in the present series, CsA was shown to be more effective. It could increase the platelet count when given together with prednisolone, the effective rate was 81.3% （ 26/32 ）. Severe side effects like kiney function failure were not found in CsA treated patients so the use of geug in ITP would be recommended. There were 2, 1 and 1 ITP patients progressing respectively to Sjogren＇s syndrome, systemic lupus erytbematosus and lymphoma. 7 patients died, 1 patient died of cerebral bleeding, 2 brain infarction, 3 malignant neoplasm and 1 nephrosis The refractory rate of ITP is 17.2% （ 10/58 ）. Conclusions The morbidity in older people is high. The mortal bleeding in ITP is low. Treatment should be tailored to the individual patient.