大剂量丙种球蛋白联合小剂量糖皮质激素治疗重症血小板减少性紫癜的临床研究

Clinical research of treatment with high-dose intravenous γ-globulin combined low dose corticosteriod in severe idiopathic thrombocytopenic purpura

目的 :评价大剂量丙种球蛋白 (HDIG)联合小剂量糖皮质激素在治疗危重症免疫性血小板减少性紫癜 (ITP)的作用。方法 :75例患者按就诊顺序随机分组。大剂量丙种球蛋白联合小剂量糖皮质激素组 (HDIG组 ) 38例 ,给予丙种球蛋白 0 .4 g· kg- 1 · d- 1 5 d,泼尼松 0 .5 mg· kg- 1 · d- 1 2 8d;糖皮质激素组 (激素组 ) 37例 ,给予泼尼松 1～ 2 mg· kg- 1· d- 1 2 8d。结果 :HDIG组中显效 2 5例 (6 5 .8% ) ,良效 9例 (2 3.7% ) ,进步 2例(5 .3% ) ,无效 2例 (5 .3% ) ,总有效率为 94 .7% ;激素组中显效 2 3例 (6 2 .2 % ) ,良效 9例 (2 4 .3% ) ,进步 3例(8.1 % ) ,无效 2例 (5 .4 % ) ,总有效率为 94 .6 %。两组治疗后血小板计数 (BPC)均较治疗前明显上升 (P均 <0 .0 1 ;BPC峰值数 HDIG组明显高于激素组〔(2 1 2 .5 6± 90 .2 5 )× 1 0 9/ L 比 (1 2 7.2 6± 81 .2 6 )× 1 0 9/ L,P<0 .0 1〕;达峰值时间 HDIG组明显短于激素组〔(7.80± 4 .5 0 ) d比 (2 7.0 0± 9.32 ) d〕。结论 :大剂量丙种球蛋白联合小剂量糖皮质激素治疗

Objective: To evaluate the effectiveness of highdose intravenous γglobulin(HDIG) combine with low dose corticosteroid in severe idiopathic thrombocytopenic purpura(ITP). Methods: A 6year retrospective study of 75 patients hospitalized with severe ITP was conducted to compare the effectiveness of corticosteroid and HDIG. HDIG group was given γglobulin 0 4 g·kg -1 ·d -1 for 5 days, and prednisolone 0 5 mg·kg -1 ·d -1 for 28 days. Corticosteroid group was given prednisolone 12 mg·kg -1 ·d -1 for 28 days. Results: In HDIG group, 25(65 8%) cases were markedly improved, 9 cases (23 7%) were more improved, 2 cases (5 3%) were improved, 2 cases (5 3%) showed no effect, the total effective rate was 94 7%, and they were 23 cases(62 2%), 9 cases (24 3%), 3 cases (8 1%), 2 cases(5 4%) and 94 6% in corticosteroid group. Blood platelet count(BPC) increased significantly after treatment in both two groups compared to those before treatment (both P <0 01), and BPCpeak values in the HDIG group〔(212 56±90 25)×10 9/L〕 were higher than that in the corticosteroid group 〔(127 26±81 26)×10 9/L〕. After treatment the time of getting BPCpeak value in the HDIG group〔(7 80±4 50) d〕 was shorter than that in corticosteroid group〔(27 00±9 32)d〕. Conclusion: HDIG combined low dose corticosteroid is more effectively in increasing the platelet count rapidly to safe levels in severe ITP.