大剂量地塞米松冲击治疗成人不同分期原发免疫性血小板减少症的近期疗效观察

Clinical short-term efficacy observation of high-dose dexamethasone in the treatment of 55 adult patients with primary immune thrombocytopenia in different stages

目的观察大剂量地塞米松冲击治疗成人不同分期原发免疫性血小板减少症(PITP)的近期临床疗效。方法回顾性分析2008年7月-2015年12月医院收治的55例成人PITP患者的临床资料,并分为新诊断PITP组(A组,17例)、持续PITP组(B组,2例)、慢性PITP组(C组,36例)。所有患者均接受地塞米松40 mg/d静脉滴注,连用4 d的单一疗程短周期治疗。采用单因素方差分析比较各期患者治疗前及治疗后第7天的血小板数,卡方检验法比较各期患者完全反应率(CR)和有效率(R)、总有效率(OR),对比初诊ITP(D组)、慢性ITP(E组)患者的CR、OR率。观察所有患者的不良反应情况。结果 A组、B组、C组患者治疗前与治疗后第7天血小板数比较差异有统计学意义(F=8.18,P=0.000)。进一步采用Dunnett's T3法比较治疗前、治疗后第7天各组间血小板数,差异均无统计学意义(P> 0.05)。A组、C组治疗后第7天血小板升高,治疗前后血小板数相比差异有统计学意义(P <0.05); B组治疗后第7天血小板升高,治疗前后血小板数相比差异无统计学意义(P> 0.05)。A组+B组与C组的CR率、R率及OR率比较差异均无统计学意义(P> 0.05)。初诊重症PITP组(D组)的CR率高于慢性重症PITP组(E组),差异有统计学意义(P <0.05)。D组和E组的OR率比较差异无统计学意义(P> 0.05)。结论大剂量DEX短疗程冲击治疗对PITP患者近期疗效好,治疗后第7天血小板明显上升。新诊断重症PITP患者的疗效优于慢性重症PITP患者。

Objective To observe the clinical short-term efficacy of high-dose dexamethasone（DEX） in the treatment of different stages primary immune thrombocytopenia（PITP） in adults.Methods Retrospective analysis the clinical datas of55 adult patients with PITP from July 2008 to December 2015.All adult patients were divided into three groups： group A（newly diagnosed PITP,n = 17）,group B（persistent PITP,n = 2）,and group C（chronic PITP,n = 36）.ALL patients were intravenously infused with DEX 40 mg/d for 4 days.One-way ANOVA was used to analysis the platelets counts before the treatment and on the 7 th day after the treatment.The rates of the complete response（CR）,the response（R） and the overall response（CR plus R） were analysized using Chi square test.The CR and OR rates of patients with newly diagnosed ITP（D group） and chronic ITP（E group） were compared.Observe the adverse reactions of all patients.Results There was a statistically significant difference in the number of platelets between the patients in group A,group B and group C before treatment and on the 7 th day after treatment（F = 8.18,P = 0.000）.There was no statistically significant difference between the two groups using Dunnett＇s T3 method before treatment and on the 7 th day after treatment（P〉0.05）.Platelets were elevated on 7 th day after treatment in group A and group C.The difference in platelet counts before and after treatment was statistically significant（P〉0.05）; platelets were elevated on 7 th day after treatment in group B,before and after treatment,but there was no significant difference in platelet count（P〉0.05）.There was no significant difference in CR rate,R rate and OR rate between group A ＋ B and group C（P〉0.05）.The CR rate of the newly diagnosed severe PITP group（D group） was higher than that of the chronic severe PITP group（E group）,the difference was statistically significant（P〈0.05）.There was no significant difference in the OR rate between group D and group E（P〉0.05）.Conclusion High-dose DEX short-course shock therapy has a good short-term effect on patients with PITP,and platelets rise significantly on the 7 th day after treatment.The efficacy of newly diagnosed patients with severe PITP is better than that of patients with chronic severe PITP.