丙种球蛋白治疗湿疹伴高IgE的ITP病儿效果

EFFECT OF GAMMA GLOBULIN ON CHILDREN WITH IMMUNE THROMBOCYTOPENIC PURPURA CONCOMITATED WITH ECZEMA AND HIGH IgE LEVEL

目的探讨湿疹伴高血清免疫球蛋白E(IgE)的免疫性血小板减少性紫癜(ITP)病儿对丙种球蛋白的治疗反应。方法收集我科2005年2月—2010年5月收治的200例ITP病儿的临床及实验室资料。将病儿分为3组:A组(无湿疹,IgE正常)69例,B组(湿疹,高IgE)75例,C组(湿疹,IgE正常)56例。评价比较各组病儿丙种球蛋白的疗效。结果丙种球蛋白治疗后3个月,病儿总有效率为93.5%,A、B、C组总有效率分别为97.1%、90.7%、92.9%,A组疗效明显优于B、C组(χ2=32.10、7.58,P<0.017),B、C两组比较差异无显著性(P>0.05)。初诊时高IgE病儿,治疗3个月时IgE下降者62例,血小板计数均有不同程度回升,治疗总有效率为96.8%;IgE未下降者13例,治疗总有效率为61.5%,两组疗效比较差异有显著性(Z=-3.060,P<0.05)。3组血小板上升时间以B组最长,用药后血小板峰值以B组最低,出血控制时间以B组最长(F=13.319～24.707,P<0.05)。A、B、C组分别有2例(2.9%)、23例(30.7%)、6例(10.7%)转为慢性ITP,B组明显多于A、C组(χ2=19.31、7.41,P<0.017)。结论湿疹伴高IgE的ITP病儿丙种球蛋白治疗效果差,易转为慢性。

Objective To observe the curative effect of gamma globulin in the treatment of immune thrombocytopenic purpura （ITP） in children with eczema and high serum IgE level. Methods Clinical and laboratory records of 200 children with ITP treated in our hospital-- from February 2005 to May 2010-- were collected and divided into three groups as group A （69 cases, with no eczema, and normal IgE level） ; group 13 （75, with eczema and high IgE）; Group C （56, with eczema and normal IgE）. The response of patients in each group to gamma globulin therapy was compared. Results The total effective rate （TER） of gamma globulin was 93.5% after three months of treatment, that in groups A, B, and C was 97.1%,90.7% and 92.9%, respec- tively, that in group A being much higher than that in groups t3 and C （x2 =32.10,7.58;P〈0.05）, and the difference of that be tween groups B and C, not significant （P〉0.05）. The high IgE levels at first visit declined in 62 cases after three months of treat- ment, blood platelet count increased in some extent, with a TER of 96.8% ; in 13 cases with no reduction of IgE, the TER was 61. 5%, the difference of curative effect between the two groups was significant （Z= -3.060 ,P〈0.05）. In group B, after medication, time consumed of platelet elevation was longest, the peak of platelet count was lowest, and the hemorrhage control time was lon- gest than groups A and C （F=13.319--24.707,P〈0.05）. Two （2.9%）, 23（30.7%） and six （10.7%） cases in groups A, I3 and C, respectively, progressed to chronic ITP, with group B being higher than groups A andC （X2-19.31,7.41;P 〈0.017）. Con- clusion The efficacy of gamma globulin therapy for children with ITP accompanying eczema and high level IgE is poor, which may lead the disease to chronic one.