不同方案治疗小儿特发性血小板减少性紫癜的疗效观察

Curative effectiveness of different protocols in the treatment of child idiopathic thrombocytopenic purpura.

目的 比较不同方案治疗小儿特发性血小板减少性紫癜 (ITP)的疗效。方法 将ITP患者分为四组 :Ⅰ组 (丙球 )、Ⅱ组 (丙球 +地塞米松 )、Ⅲ组 (地塞米松 )、Ⅳ组 (强的松 )。结果 Ⅰ～Ⅱ组止血时间、血小板上升至正常时间较Ⅳ组明显缩短 (P <0 .0 1) ,Ⅰ、Ⅱ组血小板上升峰值、总有效率明显高于Ⅳ组 (P <0 .0 1)。Ⅲ组血小板上升至正常所需时间明显长于Ⅰ、Ⅱ组 ,其上升峰值亦显著低于Ⅰ、Ⅱ组 ,但其止血时间、有效率与Ⅰ、Ⅱ组无显著差异 ,且明显优于Ⅳ组。结论 对于小儿特发性ITP尤其是血小板过低 (<2 0× 10 9/L)易致危及生命的出血 ,首选静滴丙球与地塞米松联合治疗。而对于血小板较低但全身症状不严重且经济困难的患者 ,大剂量地塞米松冲击疗法不失为一种有效、经济的治疗方法。

Objective To compare the therapeutic effect of different protocols in the treatment of idiopathic thrombocytopenic purpura (ITP).Methods ITP patients were divided into 4 group and treated with different protocols. Group Ⅰ treated with IVIG, group Ⅱ with IVIG+dexamethason, group Ⅲ with dexamethason and groupⅣ with prednison.Results The hemostatic time and the time of BPC returned to normal levels were significantly shorter, the elevated peaks of BPC, total effective rate was obviously higher in group Ⅰ and Ⅱ than in group Ⅳ. There was no significant difference in the hemostatic time and total effective rate among groups Ⅰ,Ⅱ and Ⅲ.Conclusion The children with ITP are in danger of lethal bleeding, especially the BPC count less than 20×10 9/L, and should be treated with IVIG and dexamethason by intravenous injection as the first selection. As far the patients with decreased BPC count who have slight symptom but are in poor economic situation, ictus therapy of large dosage of dexamethason is still an effective and economic treatment.