感染对儿童特发性血小板减少性紫癜的丙种球蛋白与激素治疗疗效的影响

Influence of Infections on Immunoglobulin and Glucocorticoid Efficacy in Children with Idiopathic Thrombocytopenic Purpura

目的探讨儿童特发性血小板减少性紫癜(ITP)合并感染的情况及感染对不同治疗方法疗效的影响。方法检测初治急性ITP患儿是否伴有特殊病原体感染,根据感染种类,分为特殊感染组、普通感染组及无感染组,依治疗方法的不同分为丙种球蛋白(IVIG)治疗组和IVIG联合激素治疗组;分析感染对儿童急性ITP两种治疗疗效的影响。结果特殊感染组、普通感染组及无感染组有效率分别为40.6%、78.4%、78.0%;普通感染组和无感染组的治疗有效率显著高于特殊感染组,均P<0.05;而普通感染组与无感染组之间有效率差异无统计学意义(P>0.05);对伴有特殊感染的病例,单用IVIG的治疗有效率优于IVIG联合激素治疗,有效率分别为81.8%及19.5%,P<0.05;而对普通感染组及无感染组病例,上述两种治疗有效率差异无统计学意义,普通感染患者两组有效率分别为85.7%及73.3%,无感染患者两组有效率分别为80.0%及76.9%,均P>0.05;对治疗有效的患者,约87.0%的病例在前3 d显效。结论初治时伴特殊感染的儿童ITP疗效欠佳;对有特殊感染患者,单用IVIG治疗反而较IVIG联合激素疗效好,可能与激素早期应用不利于感染清除有关。

OBJECTIVE To study infeetionrate in children with idiopathic thromboeytopenie purpura （ITP） and the influence of infections on the efficacy of ITP treatment. METHODS On cheek if children with acute ITP infect with special causative agents or not, according to infections of different kinds, the patients were separated into three groups （special infection group, common infection group and no-infection group）, and according to different managements, the children with ITP were separated into two sets： intravenous immunoglobulin （IVIG） treated group and IVIG combined with glueoeorticoid treated group, and the influence of infections on the two kinds of management in childhood ITP was analyzed. RESULTS The effective rates of special infection group, common infection group and no-infection group were 40.6%, 78. 4%, and 73.2%, respectively. Either effective rates of common infection group or no-infection group exceeded that of special infection group. The effective rates between common infection group and no-infection group had no difference. IVIG treated was better than IVIG combined with glueocorticoid treated for special infection group on effective rate （81. 8% and 19. 5%, respeetively）; however,these two kinds of management showed no difference between common infection group （85. 7% and 73.3%, respectively）and no-infection group （80. 0% and 76. 9%, respectively）on effective rates. For those patients who responded well to treatments, about 87% excellence was in the first three days. CONCLUSIONS Curative effect of naive ITP children together with special infections is poor, IVIG treated alone is better than IVIG combined with glueoeortieoid treated for those childhood ITP with special infections, for that early glueoeorticoid application may impede the clearance of infection.