难治性特发性血小板减少型紫癜脾切除的临床分析

Clinical analysis of splenectomy for treatment of refractory idiopathic thrombocytopenic purpura

目的:探讨脾切除对难治性特发性血小板减少性紫癜的治疗效果及影响因素。方法:回顾15年中行脾切除术治疗难治性ITP患者62例的临床资料,分析年龄、性别、术前有无出血、术前对激素的反应、脾脏是否肿大、术后血小板峰值与脾切除疗效之间的关系。结果:62例中,显效34例,良效13例,进步10例,无效5例;有效率(显效+良效)为75.8%。性别和脾脏是否肿大与脾切除术疗效无关(均P>0.05);有无出血症状、年龄、术后血小板峰值、骨髓巨核细胞数等因素分组间差异具有统计学意义(均P<0.05);多因素分析表明,术前对激素的反应及术前血小板计数对脾切除疗效是主要的影响因素(均P<0.05)。结论:术前对激素的反应及术前血小板计数可作为脾切除术的疗效预测指标。

Objective： To investigate the efficacy of splenectomy for refractory idiopathic thrombocytopenic purpura （ITP） and its affecting factors. Methods： The clinical data of 62 patients with refractory ITP undergoing splenectomy over 15 years were reviewed, and the relations of the efficacy of splenectomy with age gender, preoperative bleeding, preoperative response to hormone treatment, spleen enlargement, and platelet peak were analyzed. Results： Of the 62 patients, 34 were very effective cases, 13 were favorably effective cases, 10 cases were improved, and 5 cases were completely ineffective. The efficacy rate （ very effective cases plus favorably effective cases） was 75.8%. The efficacy of splenectomy was unrelated to gender and whether the spleen was enlarged （both P〈0.05）. However, the differences between the groups classified according to whether the patients had bleeding symptoms, age, postoperative platelet peak and bone marrow megakaryocyte count had statistical significance. Multivariate analysis indicated that preoperative hormone response and preoperative platelet count were the main factors affecting the efficacy of splenectomy for refractory ITP （both P〈0.05）. Conclusion： Preoperative hormone response and preoperative platelet count can be used as the prediction indexes for the efficacy of splenectomy in patients with refractory ITP.