不同剂量丙种球蛋白治疗儿童重症特发性血小板减少性紫癜的效果

Effect of Different Doses of Gamma Globulin in the Treatment of Severe Idiopathic Thrombocytopenic Purpura in Children

目的:探讨不同剂量丙种球蛋白治疗儿童重症特发性血小板减少性紫癜(ITP)的效果。方法:回顾性选取泉州市妇幼保健院·儿童医院2017年1月-2020年1月收治的82例重症ITP患儿的临床资料。按照患儿的用药剂量差异分为小剂量组和正常剂量组,各41例。两组均给予常规方案治疗,其中小剂量组采用丙种球蛋白200 mg/(kg·d)+醋酸地塞米松治疗,正常剂量组采用丙种球蛋白400 mg/(kg·d)+醋酸地塞米松治疗。比较两组患儿治疗效果、不良反应、治疗前及治疗3、7 d的血小板计数,以及症状改善时间。结果:小剂量组治疗总有效率为90.24%(37/41),正常剂量组治疗总有效率为92.68%(38/41),两组比较差异无统计学意义(P>0.05)。小剂量组不良反应发生率为4.88%(2/41),正常剂量组不良反应发生率为12.20%(5/41),两组比较差异无统计学意义(P>0.05)。治疗前及治疗3、7 d,两组血小板计数水平对比差异均无统计学意义(P>0.05)。两组血小板上升时间、出血停止时间、血小板恢复时间、住院时间对比差异均无统计学意义(P>0.05)。结论:小剂量和正常剂量丙种球蛋白治疗重症ITP的效果、不良反应风险基本相当,而降低剂量的优势在于可减少丙种球蛋白的使用,临床可酌情采用小剂量方案。

Objective:To investigate the efficacy of different doses of Gamma Globulin in the treatment of severe idiopathic thrombocytopenic purpura(ITP)in children.Method:Clinical data of 82 children with severe ITP treated in Quanzhou Maternal and Child Health Hospital·Children’s Hospital from January 2017 to January 2020 were retrospectively selected.According to the difference of drug dosage,they were divided into low-dose group and normal-dose group,41 cases in each group.Both groups were given conventional treatment,in which low-dose group was treated with Gamma Globulin 200 mg/(kg·d)+Dexamethasone Acetate,and normal-dose group was treated with Gamma Globulin 400 mg/(kg·d)+Dexamethasone Acetate.The two groups were compared for treatment effect,adverse reactions,platelet count before treatment,at 3 and 7 d of treatment and symptom improvement time.Result:The total effective rate was 90.24%(37/41)in the low-dose group and 92.68%(38/41)in the normal-dose group,there was no significant difference between the two groups(P>0.05).The incidence of adverse reactions was 4.88%(2/41)in the low-dose group and 12.20%(5/41)in the normal-dose group,there was no significant difference between the two groups(P>0.05).Before treatment,at 3 and 7 d of treatment,there were no significant differences in platelet count between the two groups(P>0.05).There were no significant differences in the platelet rising time,bleeding stop time,platelet recovery time and hospitalization time of the two groups(P>0.05).Conclusion:Low-dose and normal-dose of Gamma Globulin in the treatment of severe ITP have similar efficacy and adverse reaction risk.The advantage of reducing the dose is to reduce the use of Gamma Globulin,low-dose regimen can be used in clinical practice.