大剂量地塞米松治疗成人免疫性血小板减少症的临床研究

Clinical study of high-dose dexamethasone in the treatment of adult immune thrombocytopenia

目的：观察大剂量地塞米松短程冲击治疗对成人初发免疫性血小板减少症（ITP）的疗效及不良反应。方法：我院初诊ITP患者41例,静脉滴注地塞米松40mg/d,共4d,不进行维持治疗,观察其疗效及不良反应。结果：41例患者均完成4d大剂量地塞米松冲击治疗,完全缓解20例（48.8%）,缓解14例（34.1%）,未缓解7例（17.1%）,初期总有效率（完全缓解＋缓解）为82.9%,长期有效率为51.2%（21/41）,中位持续有效时间为19（3~42）个月。伴有抗核抗体阳性的患者,其长期有效率明显低于抗核抗体阴性者（P〈0.05）。常见不良反应有高血糖,高血压,低血钾等,在治疗结束后均恢复。结论：大剂量地塞米松短程冲击治疗,并且不进行维持治疗,对成人初发ITP有较好的疗效,治疗相关的不良反应可耐受。

Objective：To evaluate the efficiency and safety of high-dose dexamethasone in the treatment of adult newly diagnosed immune thrombocytopenia（ITP）.Method：A total of 41 newly diagnosed ITP patients received dexamethasone 40mg/d intravenously for 4days,without maintenance therapy.The efficiency and adverse reaction are evaluated.Result：All 41 patients finished 4-day high-dose dexamethasone therapy.Twenty cases（48.8%）achieved complete response,14 cases（34.1%）achieved response and 7 cases（17.1%）had no response.The overall initial response rate（complete response＋response）was 82.9%.Long-term response rate was 51.2%（21/41）.Median time of persistent response was 19 months（range,3 to 42 months）.The long-term response of patients with positive antinuclear antibody was significantly lower than that of negative cases（P〈0.05）.The most common adverse events included transient hyperglycemia,hypertension and hypokalemia.Conclusion：Single course of high-dose dexamethasone without maintenance therapy demonstrates efficiency in the newly diagnosed ITP and the treatment-related side effects are acceptable and manageable.