丙种球蛋白和地塞米松治疗儿童急性特发性血小板减少性紫癜的疗效观察

Therapeutic Effects of Immunoglobulin and Dexmethasone on Children with Acute Idiopathic Thromabocytopenic Purpura

目的 评价不同剂量静脉用丙种球蛋白 (IVIG)和地塞米松 (DEX)对急性特发性血小板减少性紫癜 (AITP)的治疗效果。方法 分别采用不同剂量IVIG及DEX随机治疗 46名AITP患儿 ,治疗后监测患儿血小板变化 ,同时观察IVIG及DEX的副作用。结果 静脉滴注IVIG 5d ,3d及DEX 3组之间治疗后血小板 (Tc)持续≤ 2 0× 10 9/L与Tc≥ 5 0× 10 9/L开始的时间无明显差异 (P >0 .0 5 ) ;IVIG组≥ 5 0× 10 9/L的人数所占比例明显增多 ,其中以IVIG 2组更显著 ,与DEX组相比差异有显著性 (χ2 =9.17,P <0 .0 5 )。结论 对于急性重症ITP患儿 ,合并严重粘膜及 /或重要脏器出血者 ,应首选IVIG治疗。

Objective To evaluate the therapeutic effect on children with acute idiopathic thrombocytopenic purpura (AITP) by intravenous immunoglobulin (IVIG) or dexmethasone (DEX). Methods Forty six patients aged from 4 months to 14 years with AITP were randomized to receive IVIG or DEX, and we monitored the platelet count (Tc) and observed the side effects after each treatment. Results There was no difference in the lasting time of Tc≤20×10 9/L and the time when Tc increased to ≥50×10 9/L between the treatment of IVIG and DEX (P> 0.05 ). But the percentage of patients with Tc≥50×10 9/L was higher in the IVIG group Ⅱ (88%) than in the DEX group (50%) after the 5 day treatment (P< 0.05 ). Conclusions We may choose IVIG to treat the patients with AITP complicated by severe mucomenbrane and organ bleeding, while we may use DEX if the patients have no complication.