老年女性特发性血小板减少性紫癜患者的临床分析

Clinical characteristics of elderly women patients with idiopathic thrombocytopenic purpura

目的探讨老年女性特发性血小板减少性紫癜（ITP）患者的临床特点、治疗、药物不良反应及转归。方法对我院住院治疗的129例老年女性ITP患者（观察组）的临床特点、骨髓情况、治疗反应、伴随疾病、不良反应进行分析，并与同期住院的年青女性患者（对照组）的临床资料进行对照。结果观察组随访时间1个月～10年，存活104例。129例患者中，均首选泼尼松治疗，有效率71．34％，与对照组差异无统计学意义（P〉0．05），对于泼尼松治疗不敏感者分别使用其他制剂，其中长春新碱34例，环孢素A28例，达那唑48例，长春新碱、环孢素A疗效与对照组相比差异无统计学意义，达那唑疗效明显优于对照组（P〈0．05）；脾栓塞较脾切除易复发。老年女性患者伴随疾病多，应用糖皮质激素更易引起血糖及血压增高，因脑出血死亡4例，对照组无脑出血死亡。结论老年女性ITP患者临床表现不典型，伴发症多，治疗中易引起糖尿病及高血压，比年轻女性更易引起致命出血，对免疫抑制剂的反应与对照组近似，对达那唑疗效较好，治疗宜个体化。

Objective To explore the clinical feature, therapy reactions, adverse drug reactions and prognosis of the elderly women patients with idiopathic thrombocytopenic purpura（ ITP）. Methods 129 cases of hospitalized elder women patients with ITP （ study group） were compared with young female （ control group） hospitalized at the same time from clinical feature, bone marrow, therapy reactions, accompany other diseases to adverse drug reaction. Results The patients in study group were followed up 1 month to 10 years, 104 patients survived. The first choice of prednisone in 129 patients treated, efficiency （71.34%）. There were no significant difference compared to control group （P 〉 0. 05）. Other agents were used for those patients who were not sensitive to prednisone, including vincristine 34 cases, cyclosporine A 28 cases, 48 cases of danazol. Though there were no significant difference among vincristine, cyclosporine A and control group, danazol were significantly better than the control group（ P 〈 0. 05 ）. Splenic embolization were easy to recur than splenectomy. Elderly female patients who were easily induced high blood sugar and blood pressure due to the usage of glucocorticoid with more other disease. 4 patients died due to cerebral hemorrhage, no patients died of cerebral hemorrhage in control group. Conclusion Elderly women patients with ITP with atypical clinical manifestations, with more accompany other diseases, more easily lead to the diabetes and hypertension during the treatment, more likely caused fatal bleeding than younger female. The response of the study group to the immune inhibitor were similar to the control group, and the efficacy of danazol well, treatment strategy should be individualized to each patients.