57例免疫性血小板减少症临床分析

Clinical analysis of 57 patients with immune thrombocytopenia

目的:探讨免疫性血小板减少症(ITP)患者的临床特征。方法:回顾性分析57例ITP患者的临床资料,统计分析患者年龄、疾病分型及分期、出血评分、治疗方案[包括糖皮质激素、人免疫球蛋白(PH4)、重组人血小板生成素注射液等]、血小板输注数量、有效反应时间、完全反应(CR)时间、免疫学相关检查等在不同组别间的差异。结果:(1)不同年龄分组和不同性别分组间出血评分值、血小板输注数量、有效反应时间及CR时间差异均无统计学意义(均P>0.05);(2)重症ITP组(37例)的出血评分值、血小板输注数量、有效反应时间均明显高于非重症ITP组(20例)(均P<0.05),而2组CR时间差异无统计学意义(P=0.277);(3)原发性ITP组(24例)与继发性ITP组(33例)在年龄、出血评分、血小板输注数量、有效反应时间及CR时间方面差异均无统计学意义(均P>0.05);(4)单药治疗组(26例)和多药联合治疗组(31例)中重症ITP患者分别占38.5%(10/26)和87.1%(27/31),差异有统计学意义(P=0.000)。结论:糖皮质激素是原发性和继发性ITP患者的有效治疗方式;对于重症ITP患者,联合药物治疗可提高疗效。

Objective:To explore the clinical characteristics of patients with immune thrombocytopenia(ITP).Method:We retrospectively analyzed the clinical data of 57 patients with ITP and statistically analyzed the difference of patients’ age,staging and classification of ITP,bleeding assessment,treatment methods[including glucocorticoid,human immunoglobulin(PH4),recombinant human thrombopoietin injection,etc.],number of platelet infusion,time to effective reaction,time to complete remission(CR)and results of immunological tests among different groups.Result:(1)There was no significant difference of values of bleeding assessment,number of platelet infusion,time to effective reaction and time to CR between subgroups divided by age and sex(all P>0.05);(2)Score of bleeding assessment,number of platelet infusion and time to effective reaction in severe ITP group(n=37)were significantly higher than those in non-severe ITP group(n=20)(all P<0.05),but there was no significant difference in time to CR between the two subgroups(P=0.277);(3)There was no significant difference in patients’ age,score of bleeding assessment,number of platelet infusion,time to effective reaction and time to CR between primary ITP group(n=24)and secondary ITP group(n=33)(all P>0.05);(4)The proportion of severe ITP patients was38.5%(10/26)in the single drug therapy group(n=26)and 87.1%(27/31)in the combination drug therapy group(n=31),respectively.There was significant difference(P=0.000).Conclusion:Glucocorticoid is an effective method for the treatment of both primary ITP patients and secondary ITP patients.And two or more drugs combination may improve the curative effects of patients with severe ITP.