摘要
目的回顾性分析比较脾切除术和免疫抑制剂分别对肾上腺糖皮质激素治疗不敏感或激素依赖的特发性血小板减少性紫癜(ITP)患者的疗效,以探讨适宜的二线治疗方案。方法收集广州市5家三级甲等医院,1997～2007年近10年间住院的所有诊断为ITP且对激素治疗无效的患者共52例,对其临床资料进行分析。根据不同的治疗方案将其分为2组,A组20例为脾切除组,B组32例为使用免疫抑制剂组(包括环孢菌素A、硫唑嘌呤、长春新碱,环磷酰胺)。分别比较两组患者在治疗前、治疗后第3天、7天、1月、6月、24月时的血小板计数(BPC)及治疗副作用。结果A组患者从治疗第3天起至24个月BPC均高于B组,差异有显著性(P<0.05)。A组的总有效率高于B组,差异有显著性(P<0.05)。A组治疗副作用包括术中出血、伤口愈合不良、脾切后继发感染等,发生率为15.0%;B组治疗不良反应包括感染、骨髓抑制、肝损害、肾损害、出血性膀胱炎、末梢性周围神经炎及其他等,发生率为45.0%。其中4例免疫抑制剂治疗无效的患者行脾切除后仍能达到有效。个别切脾后疗效不佳者仅需小剂量激素和(或)联用免疫抑制剂维持。结论对激素治疗不敏感或激素依赖的ITP患者,脾切除治疗起效时间快,效果好,副作用少,可作为激素治疗失败或不能耐受者的首选二线治疗方法。
Objective To retrospectively analyze and compare the effect of splenectomy with that of immunosuppressive therapy in patients with idiopathic thrombocytopenic purpura （ITP） unresponsive to corticosteroid therapy. Method 52 cases with diagnosed ITP who were hospitalized in 5 municipal comprehensive hospitals in Guangzhou during the year 1997 to 2007 and did not respond to corticosteroid therapy were collected and the clinical data were analyzed. Based on their different treatment regimens, the patients were divided into splenectomy group （n = 20） and immunosuppressive group （ n = 32）. Patients in the immunosuppressive group were treated with cyclosporine A, azathioprine, vincristin or cyclophosphamide. The platelet counts before the treatment and respectively 3 days, 7 days, one months, 6 months or 24 months after the treatment together with treatment-associate side effects were compared between the two groups. Results The platelet counts of spleneetomy group were higher than those of immunosuppressive group from the 3rd day to the 24 months after treatment and the difference was significant （P 〈 0.05 ）. The total effective rate of splenectomy group was significantly higher than that of immunosuppressive group （P 〈 0.05 ）. The incidence rate of side effects in spleneetomy group was 15.0% and that in the immunosuppressive group was 45.0%. Besides, 4 cases refractory to immunosuppressive therapy were still responsive to splenectomy. Very few cases who were refractory to splenectomy could be maintained with small doses of corticosteroid or combination of immunosuppressive reagents. Conclusion Splenectomy takes effects early, results in good curative effects and fewer side effects in patients with ITP refractory to corticosteroids. So splenectomy may be used as the first choice for patients fail or depend on cortieosteroids.
出处
《血栓与止血学》
2009年第1期13-16,共4页
Chinese Journal of Thrombosis and Hemostasis
基金
广州市医药卫生科研基金资助(2005A054)
关键词
特发性血小板减少性紫癜
脾切除
免疫抑制剂
疗效
副作用
Idiopathic thrombocytopenic purpura
Splenectomy
Immunodepressive
Therapeutic effect
Side effect
