慢性免疫性血小板减少性紫癜的循证治疗

Evidence-based treatment of a patient with chronic immune thrombocytopenic purpura

目的针对1例慢性免疫性血小板减少性紫癜(chronic immune thrombocytopenic purpura,CITP)患者,检索当前最佳循证治疗方案。方法根据循证临床实践的PICO原则,计算机检索Cochrane Library、MEDLINE、Embase、CBM、CNKI、VIP、万方数据库,对所获证据进行严格质量评价,采用RevMan5.0软件对纳入文献进行Meta分析,最后结合患者意愿制定治疗方案。结果共纳入18个前瞻性研究,2个系统评价,1篇临床指南。证据结果表明:检索未发现利妥昔单抗与脾切除比较的随机对照试验;利妥昔单抗对约60%的患者治疗有效,其副作用较脾切除轻且发生率低。对国内外利妥昔单抗治疗ITP的Meta分析研究结果显示,脾切除不影响利妥昔单抗的治疗效果(P>0.05)。结论慢性免疫性血小板减少性紫癜患者在脾切除之前选用利妥昔单抗治疗适当可行,也是不适宜脾切除患者的最佳选择。

Objective To retrieve the best evidence-based treatment modality for a patient with chronic immune thrombocytopenic purpura （ITP）. Methods According to the principles of patient intervention comparison outcome （PICO）, studies on chronic ITP were retrieved from Cochrane Library, MEDLINE, Embase, CBMdisc, CNKI, VIP and Wanfang databases. All studies were critically assessed and analyzed by meta-analysis using the RevMan 5.0 software. A treatment modality for chronic ITP was established according to the preference of the patient. Results Eighteen prospective studies,2 systematic reviews, and 1 study on clinical guidelines for the treatment of chronic ITP were included in the study. The evidence indicated that no random control study on comparison between the effects of rituximab and splenectomy was found in patients with chronic ITP. Rituximab was effective against chronic ITP in approximately 60% of patients. The incidence of its adverse events was lower than that of splenectomy. Meta-analysis showed that splenectomy did not influence the curative effect of rituximab on chronic ITP （P0.05）. Conclusion Rituximab can be used in treatment of chronic ITP before splenectomy and is the best choice of treatment for those at a high risk for splenectomy.