连续2个周期大剂量地塞米松治疗成人原发免疫性血小板减少症的疗效和安全性  

The efficacy and safety of 2 cycles＇ high-dose dexamethasone treatment adult primary immune thrombocytopenia

作　　者：崔中光[1] 魏昱[1] 侯明[1] 赵洪国[1] 汪洪毅[1] 

机构地区：[1]山东大学齐鲁医院血液科,济南250012

出　　处：《中华内科杂志》2011年第5期401-403,共3页Chinese Journal of Internal Medicine

基　　金：基金项目：国家自然科学基金（30570779、30600259、30600680、30770922、30800491、30801258、30971278）;山东省自然科学基金（ZR2009CM001）;教育部科学技术研究重点项目（109097）;卫生部临床学科重点项目;泰山学者建设工程专项经费

摘　　要：目的 观察连续2个周期大剂量地塞米松对成人新诊断的原发免疫性血小板减少症（ITP）患者的疗效及安全性.方法 将59例新诊断的ITP患者随机分为两组,地塞米松治疗组30例,地塞米松40 mg/d,连用4 d,7 d后再重复1个周期,以后不进行维持治疗;泼尼松治疗组29例,1.0～1.5 mg·kg-1·d-1口服,连用4周后逐渐减量.观察二组间的近、远期疗效和安全性.结果 近期疗效：治疗后第1、2周地塞米松组有效率明显高于泼尼松组（50.0%比24.1%,73.3%比55.2%,P值分别＜0.01和0.05）,治疗后第3周有效率仍高于泼尼松组,但差异无统计学意义（83.3%比68.9%,P＞0.05）.远期疗效：随访3个月,除第1个月地塞米松组复发率与泼尼松组差异无统计学意义（16.0%比20.0%,P＞0.05）,第2、3个月地塞米松组复发率均明显低于泼尼松组（24.0%比40.0%,32.0%比65.0%,P值分别＜0.05和0.01）.地塞米松组不良反应轻微,无1例并发感染及出现库欣综合征.结论 大剂量地塞米松治疗ITP的近、远期疗效均优于常规制量泼尼松且安全性好.Objective To investigate the efficacy and safety of a schedule of 2 cycles＇ high-dose dexamethasone （HD-DXM） as an initial therapy in adults immune thrombocytopenia （ITP）, and compare with conventional dose prednisone therapy. Method A total of 59 newly diagnosed ITP patients were divided into 2 groups randomly. In 30 patients （ Dexamethasone group）, oral HD-DXM was administered at 40 mg/d for 4 consecutive days, repeated one week later, and then failed to maintain. In the remaining 29and then gradually tapered. Results For short-term efficacy, after 1 and 2 weeks of treatment, the response rate in Dexamethasone group was significantly higher than that in Prednisone group （50. 0% vs 24. 1%, P 〈0. 01; 73.3% vs 55.2%, P 〈0. 05 ）, while 3 weeks later, there was no remarkable difference between the two groups（83.3% vs 68.9%, P 〉 0. 05 ）, though the response rate in Dexamethasone group remained higher. For long-term effect, at the end of the 2nd and 3rd months of follow-up, the relapse rate in Dexamethasone group was significantly lower than that in Prednisone group（24. 0% vs 40. 0%, P 〈 0. 05;32.0% vs 65. 0%, P 〈 0. 01 ）, while at the end of the 1st month of follow-up, there was no significant difference（ 16. 0% vs 20. 0%, P 〉0.05 ）. In addition, it＇s well tolerated and no complications such as severe infection or Cushing syndrome were complained in Dexamethasone group. Conclusion HD-DXM possesses an advantage over conventional dose prednisone therapy in efficacy and safety.

关 键 词：地塞米松 泼尼松 治疗结果 安全 原发免疫性血小板减少症 

分 类 号：R558.2[医药卫生—血液循环系统疾病]