国际工作组免疫性血小板减少新分期标准与糖皮质激素疗效的关系

The effects of corticosteroid treatment on immune thrombocytopenia under new diagnostic criteria

目的 探讨免疫性血小板减少（ITP）在新的诊断标准与分期下的规范化一线治疗方案.方法 对山东大学齐鲁医院2004年3月至2009年11月间使用大剂量地塞米松冲击治疗或泼尼松方案治疗的178例成人ITP患者进行回顾性分析.结果 178例患者中位年龄41岁;按新分期标准,在可评价分期的175例患者中,新诊断ITP 87例（49.7%）,持续性ITP 30例（17.1%）,慢性ITP58例（33.1%）;其中可评估疗效者167例,有效率分别为77.4%（65/84）、64.0%（16/25）、62.1%（36/58）,完全缓解率分别为57.1%（48/84）、36.0%（9/25）、32.8%（19/58）;新诊断ITP组的有效率及完全缓解率均显著高于慢性ITP组（χ^2=3.917,P＜0.05;χ^2=8.186,P＜0.01）;大剂量地塞米松治疗组与泼尼松治疗组在性别、年龄、治疗前血小板计数等方面差异均无统计学意义,两种治疗方案近、远期有效率及完全缓解率差异无统计学意义而前者的起效时间显著短于后者（F=10.34,P＜0.01）,且副作用小.结论 新的分期标准规范科学.大剂量地塞米松冲击治疗可作为首选治疗方案.

Objective To address the standard first-line management under the new diagnostic criteria in adult immune thrombocytopenia （ITP）. Methods A retrospective analysis was conducted involving 178 adult ITP patients treated with high-dose dexamethasone or prednisone in Qilu Hospital from March 2004 to November 2009 using new diagnostic criteria. Results The median age was 41 years with a male/female ratio of 0. 73： 1. Among the 178 ITP patients, 87 were newly diagnosed, 30 persistent ITP, 58 chronic ITP, and 3 unable to follow up. The efficacy rates among 167 patients able to assess in the three groups were 77.4% （ 65/84 ）, 64. 0% （ 16/25 ） and 62. 1% （ 36/58 ） respectively, and their complete remission （CR） rates were 57. 1% （48/84）, 36. 0% （9/25） and 32. 8% （19/58）. The efficacy rate and CR rate of the newly diagnosed ITP category were significantly higher than those of the chronic ITP category （χ^2 = 3. 917, P 〈 0. 05 ;χ^2 = 8. 186, P 〈 0. 01 ）. The patients treated with high-dose dexamethasone or prednisone therapy had no significant differences in sex, age or blood platelet count before treatment.Moreover, the short or long term response rates and the CR rates between the two therapies had no statistically significant differences while the former had a shorter onset time （ F = 10. 34, P 〈 0. 01 ）.Conclusions The study sets up a basis for the application of the recommended new definition and outcome criteria for adult ITP. Dexamethasone therapy is favored as first-line therapy.