不同剂量丙种球蛋白联合糖皮质激素治疗儿童特发性血小板减少性紫癜的疗效观察

Observation on the Effect of Different Doses of Gamma Globulin Combined with Glucocorticoid in the Treatment of Idiopathic Thrombocytopenic Purpura in Children

目的:探究不同剂量丙种球蛋白+糖皮质激素治疗儿童特发性血小板减少性紫癜(ITP)的临床效果。方法:纳入某院收治的2017年10月~2020年10月96例ITP患儿,按随机数字表法分为对照组和观察组各48例,对照组采用大剂量丙种球蛋白+地塞米松,观察组采用小剂量丙种球蛋白+地塞米松。比较两组治疗效果、免疫功能、血小板变化情况及安全性。结果:观察组治疗总有效率、不良反应发生率分别为83.33%、10.42%,略低于对照组的87.50%、14.58%,差异无统计学意义(P>0.05)。治疗前、治疗后两组免疫功能比较,差异无统计学意义(P>0.05);治疗后,两组免疫球蛋白G、A、M(IgG、IgA、IgM)水平均显著高于治疗前,差异有统计学意义(P<0.05)。与对照组相比,观察组血小板上升、出血停止、血小板上升至正常时间均略高,无统计学差异(P>0.05);血小板达峰时间高于对照组,差异有统计学意义(P<0.05)。结论:不同剂量丙种球蛋白+糖皮质激素治疗儿童ITP疗效相当,均可缩短血小板上升时间、血小板上升至正常时间,减少出血量,改善免疫功能,小剂量丙种球蛋白可在一定程度上降低患者不良反应发生率,且利于减轻家庭负担,值得推广应用。

Objective:To explore the clinical effects of different doses of gamma globulin+glucocorticoid in the treatment of children with idiopathic thrombocytopenic purpura(ITP).Methods:A total of 96 children with ITP who were admitted to a hospital from October 2017 to October 2020 were enrolled and divided into control group and observation group according to the random number table method,with 48 cases in each group.The control group was given a large dose of gamma globulin+dexamethasone,and the observation group was given a small dose of gamma globulin+dexamethasone.The treatment effect,immune function,platelet changes and safety of the two groups were compared.Results:The total effective rate of treatment and the incidence of adverse reactions in the observation group were 83.33%and 10.42%,respectively,which were slightly lower than 87.50%and 14.58%in the control group.The difference was not statistically significant(P>0.05).There was no statistically significant difference in the immune function between the two groups before and after treatment(P>0.05);After treatment,the levels of immunoglobulin G,A,and M(IgG,IgA,IgM)in the two groups were significantly higher than those before treatment.The difference was statistically significant(P<0.05).Compared with the control group,the time for platelet rise,bleeding stop,and platelet rise to normal in the observation group were slightly longer,and there was no statistical difference(P>0.05);The platelet peak time was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:Different doses of gamma globulin+glucocorticoids are effective in the treatment of children with ITP,which can shorten the time of platelet rise,the time for platelets to rise to normal,reduce bleeding,and improve immune function.Small dose of propylene globulin can reduce the incidence of adverse reactions in patients to a certain extent,and is conducive to reduce the burden of the family,which is worthy of promotion and application.