特发性血小板减少性紫癜48例临床分析

Clinical Analysis of 48 Cases of ITP

目的分析特发性血小板减少性紫癜(ITP)的病因及治疗方案的选择。方法收集汉中市人民医院于2010年10月至2012年5月收治的ITP患者48例,其中35例初治患者依据随机数字表法分为单纯糖皮质激素冲击治疗组(18例)和糖皮质激素+丙种球蛋白治疗组(17例),12例复发难治患者采用丙种球蛋白抗体封闭治疗,1例病程长达5年且反复使用糖皮质激素冲击治疗三次均有效,但不能长期维持疗效的患者最终选择脾脏切除治疗。观察两组初治疗患者的临床疗效及血小板情况,分析四种治疗方案中ITP的临床表现、诱发原因及治疗方法的选择。结果糖皮质激素+丙种球蛋白治疗组的临床疗效优于单纯糖皮质激素冲击治疗组(88.23%vs61.11%),差异有统计学意义(P<0.05);糖皮质激素+丙种球蛋白治疗组血小板开始上升时间和恢复正常时间显著短于单纯糖皮质激素冲击治疗组,差异均有统计学意义(P<0.05);糖皮质激素+丙种球蛋白对难治复发性血小板减少性紫癜患者依然有效。结论对于ITP患者的治疗,早期应用丙种球蛋白可显著促进血小板的早期恢复,应作为一线治疗药物。

Objective To retrospectively analyze causes and treatment programs of idiopathic thrombocytopenic purpura（ITP）.Methods From Hanzhong City People＇ s Hospital during October 2010 and May 2012,48 patients with ITP were collected,including 35 patients without previous treatment,and were randomly divided into corticosteroid therapy alone group（18 cases） and glucocorticoids ＋ gamma globulin treatment group（17 cases）,and 12 relapsed or refractory patients were treated with gamma globulin antibody blocking therapy,one case of duration of up to five years and repeated three times effective corticosteroid therapy but not long-term maintenance curative effect,was finally treated with splenectomy.Early clinical efficacy and platelets of the two groups of first treatment were observed,ITP clinical manifestations,induction causes and treatment selection among the four treatment options were analyzed.Results The clinical efficacy of glucocorticoid ＋ gamma globulin treatment group was better than corticosteroid treatment group（88.23% vs 61.11%）,the difference was statistically significant（P 0.05）;platelets of glucocorticoids ＋ gamma globulin treatment group begin-to-rise time and recovery time was significantly shorter than that of corticosteroid treatment group,and the differences were statistically significant（P 0.05）;glucocorticoids ＋ gamma globulin was still valid for refractory recurrent thrombocytopenic purpura patients.Conclusion For ITP patient treatment,early application of gamma globulin can significantly promote the early recovery of platelets,which should be used as a front-line treatment.