大剂量甲泼尼龙和大剂量丙种球蛋白冲击治疗成人重症特发性血小板减少性紫癜短期疗效评估

The short-term responses between high dose methylprednisolone and high dose intravenous immunoglobulin as initial therapy for severe idiopathic thrombocytopenic purpura in adult

目的观察大剂量甲泼尼龙(HDMP)和大剂量丙种球蛋白(HDIVIG)冲击治疗重症特发性血小板减少性紫癜(ITP)的短期疗效。方法 32例血小板<10×109/L的成人重症ITP患者随机分成HDMP和HDIVIG两组。HDMP组18例,给予甲泼尼龙1.0g/d,连用3d,接泼尼松1.5mg/(kg·d)。HDIVIG组14例,给予丙种球蛋白0.4g/(kg·d),连用3d,接泼尼松1.5mg/(kg·d)。治疗后7～10d测血小板数目。结果 HDMP组和HDIVIG组血小板上升至20×109/L需(4.1±1.8)天和(3.3±1.6)d。达50×109/L分别为(6.5±2.7)d和(5.9±2.5)d,差异均无统计学意义(P分别>0.20和>0.50)。结论大剂量甲泼尼龙和大剂量丙种球蛋白治疗成人重症ITP短期提升血小板疗效相似。甲泼尼龙相对廉价,可广泛使用。

Objective To compare the short-term response between high dose methylprednisolone （ HDMP） and high dose intravenous immunoglobulin（ HDIVIG） in treating adults with severe idiopathic thrombocytopenic purpura（ ITP）. Methods Thirty-two adults with severe ITP and a platelet count below 10 × 10^9 /L were randomized to receive either 1. 0 g/（ kg·d） （ n = 18; group HDMP） or 0. 4 g/kg/d （ n = 14; group HDI-VIG） for 3 consecutive days,after that,every case was administered with prednisone[1. 5 mg/（ kg·d） =. Platelet counts were measured daily up to day 7 ～ 10. Results The days platelet ascending to 20 × 10^9 /L and 50 × 10^9 /L were（ 4. 1 ± 1. 8） and（ 6. 5 ± 2. 7） respectively in the HDMP group compared with（ 3. 3 ± 1. 6） and （ 5. 9 ±2. 5） respectively in the HDIVIG group. There was no significant difference in the time platelet ascending to the above counts between the two groups with P 〉0. 20 and P〉 0. 50 respectively. Conclusion Both HDMP and HDIVIG treatments to severe ITP in adults are effective. The short-term responses of the two agents are similar. In contrast to intravenous immunoglobulin,methylprednisolone is cheep,so it may be widely used.