重症特发性血小板减少性紫癜21例临床分析

Clinical Analysis on Treatment of Severe Idiopathic Thrombocytopenic Purpura:a Report of 21 Cases

目的分析重症特发性血小板减少性紫癜(ITP)治疗的临床疗效及预后转归。方法对21例重症ITP患者初始给予糖皮质激素+静脉免疫球蛋白±血小板输注的联合治疗方案;对幽门螺杆菌感染阳性的患者给予抗HP根治治疗;对多种治疗措施不能持久符合切脾指征的患者行切脾术;观察治疗后临床出血症状及血小板计数的变化。结果 21例联合方案治疗初始完全反应约占90%,无效约占10%;4例幽门螺杆菌检测阳性的患者给予抗HP治疗,2例有效;4例切脾患者3例完全反应。结论初始联合治疗方案对患者度过危险期,改善出血症状疗效显著;对ITP患者应常规行幽门螺杆菌检测;切脾治疗ITP效果肯定。

Objective To investigate the clinical efficiency,outcome and prognosis of severe idiopathic thrombocytopenic purpura（ITP）.Methods The primary combined therapeutic scheme with glucocorticosteroid,intravenous immunoglobulin and platelet transfusion were performed in 21 cases with ITP.The anti-Hp infection eradication therapy was carried out in cases with positive Helicobacter pylori infection.The splenectomy was performed in patients who could not achieve lasting effect by different kinds of routine therapeutic methods and with indications for splenectomy.The clinical hemorrhagic symptoms and platelet count were observed.Results In all 21 cases received primary combined therapeutic scheme,19 cases（90%）were in complete response（CR）and 2 cases（10%）were in no response（NR）.4 cases with positive Hp infections received anti-Hp treatment,and 2 cases were in partial response（R）;3 of 4 cases who underwent splenectomy achieved CR.Conclusion The combined therapeutic scheme with glucocorticosteroid,intravenous immunoglobulin and platelet transfusion can help patients to pass the dangerous period and improving the hemorrhagic symptoms.The routine Hp test should be taken in patients with ITP and splenectomy has a positive effect on ITP.