大剂量地塞米松与传统泼尼松治疗原发免疫性血小板减少症效果比较  

HIGH-DOSE DEXAMETHASONE VERSUS CONVENTIONAL PREDNISONE IN THE TREATMENT OF PRIMARY IMMUNE THROMBOCYTOPENIA

作　　者：崔中光[1] 史雪[1] 鞠小妍[1] 刘竹珍[1] 汪洪毅[1] 赵洪国[1] 

机构地区：[1]青岛大学医学院附属医院血液科,山东青岛266003

出　　处：《青岛大学医学院学报》2013年第6期528-530,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的比较大剂量地塞米松与传统泼尼松治疗成人初治原发免疫性血小板减少症（ITP）的效果及安全性。方法初治ITP病人73例，随机分为两组，地塞米松组37例，给予地塞米松40mg／d分2次口服，连用4d，停药后第7天再重复一个周期，以后不再维持治疗；泼尼松组36例，给予泼尼松1．0～1．5mg／（kg·d）口服治疗，连用4周后逐渐减量至最小维持剂量或停药。观察并比较两组的近期疗效、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，差异有显著性（x^2=7．21、4．30，P〈o．05）；治疗后第3周地塞米松组有效率仍高于泼尼松组，但差异无显著性（x^2=1．56，P〉0．05）。远期疗效：随访3个月，第1个月地塞米松组复发率与泼尼松组比较差异无显著性（x^2=0．11，P〉0．05），第2、3个月地塞米松组复发率明显低于泼尼松组，差异有显著性（Z。：4．49、4．80，P〈0．05）。地塞米松组不良反应轻微，无并发感染及出现柯兴综合征者；而泼尼松组多数病人出现柯兴综合征表现，部分病人并发感染。结论大剂量地塞米松治疗成人初治ITP的近期、远效果均优于常规剂量泼尼松，且安全性好。Objective To compare the efficacy and safety of high-dose dexamethasone （HD-DXM） with conventional prednisone in the treatment of adults with primary immune thrombocytopenia （ITP）. Methods A total of 73 newly diagnosed ITP patients were divided into two groups in random. Dexamethasone group （DXM group, 37 patients） ： oral DXM 40 rag/d, to be taken in two doses, for 4 days and then discontinued, which was repeated for one more cycle on day 7 after the discontinuation. Prednisone group （36 patients）, oral prednisone 1.0-1.5 mg · kg ^-1· d^- 1 for 4 weeks, and then the dose was gradually decreased to minimum maintenance dose or discontinued. The short-term and long-term efficacy and safety were compared between the two groups. ResuJts For short-term efficacy, after 1 2-week treatment, the response in Dexamethasone group was significantly higher than that in Prednisone group （x2=7.21,4.30;P〈0.05）, the efficacy on week 3 remained higher, but the difference was not statistically significant （x^2 =1.56,P〉0.05）. For long-term effect, a three-month follow up showed that, on the first month, the recurrence rate between the two groups was not significant （%z =0,11 ,P〉0.05）, and that on the second and the third month was much lower in Dexamethasone group than that in Prednisone group （x^2 =4.49,4.80;P〈0.05）. In Dexamethasone group, little adverse reactions such as infections or Cushing syndrome were observed; In Prenisone group, Cushing syndrome manifestations were seen in more patients, and some complicated infections were also noted, Conclusion High-dose DXM therapy for ITP is superior than routine-dose Prednisone in terms of short- and long-term efficacy and safety.

关 键 词：地塞米松 泼尼松 治疗结果 紫癜 血小板减少性 特发性 

分 类 号：R558[医药卫生—血液循环系统疾病]