以血小板减少为首发症状的结缔组织病与免疫性血小板减少性紫癜的鉴别诊断

The differential diagnosis of connective tissue disease with thrombocytopenia and immune thrombocytopenic purpura

目的通过对以血小板(platelet,PLT)减少为首发症状的结缔组织病(connective tissue disease,CTD)和免疫性血小板减少性紫癜(immune thrombocytopenic purpura,ITP)的实验室相关检测指标及治疗疗效的分析研究,寻求其鉴别诊断方法。方法收集我院2014年3月-2015年6月住院的18例以PLT减少为首发症状的CTD患者为CTD组和22例ITP患者为ITP组,对所有患者的实验室检测指标及临床治疗效果进行分析。结果 CTD组的血红蛋白、C3、C4显著低于ITP组,而PLT、血沉和Ig G均显著高于ITP组,差异均有统计学意义(P均<0.05)。CTD组患者临床治疗的总有效率较高,为94.4%,其中单纯采用激素治疗及联合免疫抑制剂治疗的有效率(66.7%,16.7%)均高于ITP组患者(50.0%,13.6%),而采用丙种球蛋白/重组人血小板生成素治疗的有效率(11.1%)低于ITP组患者(18.2%)。结论以PLT减少为首发症状的CTD发病人群以中青年女性居多,ITP的发病人群年龄跨度较大。但这两种疾病的临床表现相似,故应结合实验室相关检测指标进行鉴别。对于临床表现不典型的CTD合并PLT减少患者,还需动态监测其自身抗体谱以进一步确诊,且确诊后建议及时应用激素联合免疫抑制剂治疗。

Objective To analyse the related laboratory indexes and clinical therapeutic effect of connective tissue disease（CTD） with thrombocytopenia and immune thrombocytopenic purpura（ITP）.And to investigate the differential diagnosis of these two diseases.Methods 18 cases CTD with thrombocytopenia patients（CTD group） and 22 cases ITP patients（ITP group） were collected in our hospital from March 2014 to June 2015.The laboratory detection and clinical therapeutic effect of all patients were analyzed.Results The levels of hemoglobin,C3,C4 in CTD group were lower than that of ITP group,but the platelet,erythrocyte sedimentation rate and IgG were higher than that of ITP group,and the differences all had statistical significance（Pall 〈0.05）.The total effective rate of 18 cases CTD patients was higher（94.4%）.The effective rates of treated by hormone only and combined with immunosuppressive agents in CTD patients（66.7%,16.7%） were higher than that of ITP patients（50.0%,13.6%）,but the effective rate of treated by gamma globulin / recombinant human thrombopoietin（11.1%） was lower than that of ITP patients（18.2%）.Conclusion The incidence of crowd of CTD with thrombocytopenia is young and middle-aged female,and ITP has large age span.These two diseases have similar clinical feature.It should combined with laboratory index to differentiating.For clinical manifestation is not typical of CTD with thrombocytopenia patients,which should dynamic monitoring autoantibodies to confirmed diagnosis,and treated by hormone combined with immunosuppressive agents in time.