儿童慢性血小板减少性紫癜的治疗进展(2)
2.6 抗CD40L抗体 (Antova) CD40 是一种表达于B 淋巴细胞膜上的糖蛋白在B 淋巴细胞的生长、发育以及分化等过程中都起着重要作用。而CD40 配体是一种表达在激活的T 淋巴细胞膜上的糖蛋白，在体液免疫中起了重要作用。Antova能够阻止CD154 结合CD40从而抑制B细胞分化和激活，减少自身抗体的产生而治疗ITP。ITP患者存在大量CD4+T细胞，CD40配体可介导活化T细胞依赖的B细胞扩增，所以抗CD40L抗体可能在CITP中具有治療作用，无明显毒副作用。
综上所述，儿童CITP的有效治疗方法有激素、IVIG、anti-D、脾脏切除及免疫抑制剂，免疫抑制剂等可作为新的治疗选择，但在儿童CITP中尚需要进一步循证治疗研究。
参考文献
[1] 中华医学会儿科学分会血液学组，《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志，2013， 51(5)： 382-384.
[2] Abdel-Hamid SM， Al-Lithy HN. B cell activating factor gene polymorphisms in patients with risk of idiopathic thrombocytopenic purpura[J].The American journal of the medical sciences， 2011，342(1)： 9一14. ？
[3] Zilber R，Bortz AP，Yacobovich J，et al. Analysis of health-related quality of life in children with immune thrombocytopenia and their parents using the kids' ITP tools[J]. J Pediatr Hematology Oncology，2012，34(1)：2-5.
[4] Klaassen RJ，Blanchette V，Burke TA，et al. Quality of life in childhood immune thrombocytopenia：international validation of the kids' ITP tools[J].Pediatr Blood Cancer，2013，60(1)：95-100.
[5] Gudbrandsdottir S，Birgens HS，Frederiksen H，et al. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia[J].Blood，2013，121(11)：1976-1981.
[6] Patel VL， Mahevas M， Lee SY， et al. Outcomes 5 years after response to rituximab therapy119(25)：in children and adults with immune thrombocytopenia[J].Blood， 2012：5989-5995.
[7] Choudhary DR， Naithani R， Mahapatra M， et al. Efficacy of cyclosporine as a Single agent therapy in chronic idiopathic thrombocytopenic purpura[J].31 Haematologica， 2008， 93(10)： e61-e62.
[8] Gwilliam NR，Lazar DA，Brandt ML，et al.An analysis of out-comes and treatment costs for children undergoing splenectomy for chronic immune thrombocytopenia purpura[J].J Pediatr Surg，2012，47(8)：1537-1541., http://www.100md.com(杨青 宋春艳 李娜)
综上所述，儿童CITP的有效治疗方法有激素、IVIG、anti-D、脾脏切除及免疫抑制剂，免疫抑制剂等可作为新的治疗选择，但在儿童CITP中尚需要进一步循证治疗研究。
参考文献
[1] 中华医学会儿科学分会血液学组，《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志，2013， 51(5)： 382-384.
[2] Abdel-Hamid SM， Al-Lithy HN. B cell activating factor gene polymorphisms in patients with risk of idiopathic thrombocytopenic purpura[J].The American journal of the medical sciences， 2011，342(1)： 9一14. ？
[3] Zilber R，Bortz AP，Yacobovich J，et al. Analysis of health-related quality of life in children with immune thrombocytopenia and their parents using the kids' ITP tools[J]. J Pediatr Hematology Oncology，2012，34(1)：2-5.
[4] Klaassen RJ，Blanchette V，Burke TA，et al. Quality of life in childhood immune thrombocytopenia：international validation of the kids' ITP tools[J].Pediatr Blood Cancer，2013，60(1)：95-100.
[5] Gudbrandsdottir S，Birgens HS，Frederiksen H，et al. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia[J].Blood，2013，121(11)：1976-1981.
[6] Patel VL， Mahevas M， Lee SY， et al. Outcomes 5 years after response to rituximab therapy119(25)：in children and adults with immune thrombocytopenia[J].Blood， 2012：5989-5995.
[7] Choudhary DR， Naithani R， Mahapatra M， et al. Efficacy of cyclosporine as a Single agent therapy in chronic idiopathic thrombocytopenic purpura[J].31 Haematologica， 2008， 93(10)： e61-e62.
[8] Gwilliam NR，Lazar DA，Brandt ML，et al.An analysis of out-comes and treatment costs for children undergoing splenectomy for chronic immune thrombocytopenia purpura[J].J Pediatr Surg，2012，47(8)：1537-1541., http://www.100md.com(杨青 宋春艳 李娜)