大剂量甲泼尼龙和大剂量丙种球蛋白冲击治疗成人重症特发性血小板减少性紫癜短期疗效评估(1)
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【摘要】 目的 观察大剂量甲泼尼龙(HDMP)和大剂量丙种球蛋白(HDIVIG)冲击治疗重症特发性血小板减少性紫癜(ITP)的短期疗效。方法 32例血小板<10×109/L的成人重症ITP患者随机分成HDMP和HDIVIG两组。HDMP组18例,给予甲泼尼龙1.0g/d,连用3d,接泼尼松1.5mg/(kg•d)。HDIVIG组14例,给予丙种球蛋白0.4g/(kg•d),连用3d,接泼尼松1.5mg/(kg•d)。治疗后7~10d测血小板数目。结果 HDMP组和HDIVIG组血小板上升至20×109/L需(4.1±1.8)天和(3.3±1.6)d。达50×109/L分别为(6.5±2.7)d和(5.9±2.5)d,差异均无统计学意义(P分别>0.20和>0.50)。结论 大剂量甲泼尼龙和大剂量丙种球蛋白治疗成人重症ITP短期提升血小板疗效相似。甲泼尼龙相对廉价,可广泛使用。
【关键词】
特发性血小板减少性紫癜;甲泼尼龙;丙种球蛋白
The short-term responses between high dose methylprednisolone and high dose intravenous immunoglobulin as initial therapy for severe idiopathic thrombocytopenic purpura in adult
WU Zhen-tian, CHEN Rong, YUAN Zhong-yong, et al.Hematology department of Mindong Hospital affiliated Fujian Medical University, Fu’an 355000,China
【Abstract】 Objective To compare the short-term response between high dose methylprednisolone (HDMP) and high dose intravenous immunoglobulin(HDIVIG) in treating adults with severe idiopathic thrombocytopenic purpura(ITP). Methods Thirty-two adults with severe ITP and a platelet count below 10×109/L were randomized to receive either 1.0 g/(kg•d)(n=18;group HDMP) or 0.4 g/kg/d (n=14; group HDIVIG) for 3 consecutive days, after that, every case was administered with prednisone[1.5 mg/(kg•d)=. Platelet counts were measured daily up to day 7~10. Results The days platelet ascending to 20×109/L and 50×109/L were(4.1±1.8) and(6.5±2.7) respectively in the HDMP group compared with(3.3±1.6)and(5.9±2.5) respectively in the HDIVIG group. There was no significant difference in the time platelet ascending to the above counts between the two groups with P>0.20 and P>0.50 respectively. Conclusion Both HDMP and HDIVIG treatments to severe ITP in adults are effective. The short-term responses of the two agents are similar. In contrast to intravenous immunoglobulin, methylprednisolone is cheep, so it may be widely used.
【Key words】 idiopathic thrombocytopenic purpura; methylpredhnisolone; immunoglobulin
特发性血小板减少性紫癜(idiopathicthrombocytopenicpurpura,ITP)为血液科常见病、多发病。血小板减少,特别是<10×109/L的重症ITP,可致全身出血表现,严重者可致命。短期提升血小板予渡过安全期是治疗重症ITP的关键。大剂量甲泼尼龙(highdosemethylprednisolone,HDMP)和大剂量丙种球蛋白(highdoseintravenousimmunoglobulin,HDIVIG)冲击治疗为常用方案。本文比较两者在重症ITP中的疗效,现报告如下。
1 资料与方法
1.1 病例资料 按文献1诊断32例2009年1月至2010年5月我科住院初发成人ITP患者,血小板均<10×109/L。其中男13例,女19例,平均年龄37.6岁。病例随机分2组,HDMP组18例,HDIVIG组14例。两组性别、年龄及初发血小板数差异无统计学意义,具有可比性。
1.2 给药方法 HDMP组 静脉滴注甲泼尼龙1 ......
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