联合使用免疫抑制剂治疗难治性原发免疫性血小板减少症  

Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia

作　　者：马丽[1] 吴春农[1] 谢晓英[1] 周云[1] 

机构地区：[1]四川省凉山彝族自治州第一人民医院血液内科,四川省西昌市615000

出　　处：《临床合理用药杂志》2012年第2期15-16,共2页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察联合多种免疫抑制剂治疗难治性原发免疫性血小板减少症(ITP)的疗效和安全性。方法37例难治性ITP患者随机分为治疗组17例和对照组20例。对照组先予甲基强的松龙每天1g及免疫球蛋白每天0.4g.kg-1.d-1静脉滴注,3～5d血小板上升后接受强的松1mg.kg-1.d-1口服,2周后逐渐减量至维持治疗;治疗组联合2～3种静脉免疫抑制剂(免疫球蛋白每天0.4g.kg-1.d-1,长春新碱每天2mg,甲基强的松龙1g)治疗3～5d,血小板迅速上升后给予联合2～3种口服免疫抑制剂(包括达那唑200mg每天2次,环孢素50mg每天2次,吗替麦考酚酯1g每天2次)。维持治疗3～6个月。治疗结束后随访1～3年。结果治疗组总有效率为88.2%高于对照组的55.0%,差异有统计学意义(P<0.01)。治疗组血小板计数平均99.8×109/L,高于对照组的22.4×109/L;治疗组血小板稳定时间平均19.1个月,高于对照组的1.5个月,差异均有统计学意义(P<0.01)。总体耐受性良好,无1例出现严重并发症。结论联合多种免疫抑制剂治疗难治性ITP安全有效,且可长期维持血小板值稳定于安全范围。Objective To observe the clinic effects and safety of combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia（ITP）.Methods 37 patients with refractory ITP were randomly divided into treatment group（17 patients） and control group（20 patients）.The control group was treated with methylprednisolone1g/d and IVIG0.4g/kg/d for 3~5 days,then took prednisone 1mg/kg/d orally for 2 weeks to become gradually reduced to maintenance.The treatments were administrated with a 2-or3-drug intravenous combination immunosuppressant including methylprednisolone 1g/d,IVIG0.4g/kg/d,Vinca alkaloids 2mg/d Methylprednisolone 1g/d to rapidly increase the platelet count,then given a 2-or3-drug oral maintenance treatment with danazol 200mg bid,cyclosporine 50mg bid and mycophenolate mofetil 1g bid.The oral treatment maintained for 3~6 months.The duration of follow-up was 36 months.Results The total effect rate in treatment group and control group was 88.2% and 55.0% respectively,and the difference was significant（P0.01）.TThe platelet average of treatment group was higher than that of the control group（99.823×109/L vs 22.350×109/L,P=0.00）.The average maintenance time of platelet count were 19.117monthes and 15.000monthes,and the differences were significant（P0.01）.Treatments were well tolerated,none had serious complication.Conclusion Combination chemotherapy is a useful approach for patients with refractory ITP which could maintain a long-term safe platelet count.

关 键 词：血小板减少症 免疫性 难治性 免疫抑制剂 

分 类 号：R558.2[医药卫生—血液循环系统疾病]