地塞米松冲击治疗继发于Graves病的重型免疫性血小板减少症临床观察  

Clinical observation of dexamethasone pulse therapy for treating severe immune thrombocytopenia secondary to Graves disease

作　　者：阮力[1,2] 舒更新[1,2] 杨俊杰[1,2] 熊芝兰[1,2] 向群[1,2] 

机构地区：[1]怀化医学高等专科学校附属铁路医院 [2]怀化市第五人民医院血液病室,怀化418000

出　　处：《右江医学》2014年第2期225-228,共4页Chinese Youjiang Medical Journal

摘　　要：目的观察地塞米松（Dex）冲击治疗继发于Graves病的重型免疫性血小板减少症的疗效。方法9例继发于Graves病的重型免疫性血小板减少症患者给予Dex冲击治疗，具体为：Dex剂量为0．3～0．45mg／（kg·d），0．9％氯化钠液稀释后静脉推注，连用3天，第4天减量至10mg，第5天改为泼尼松1mg／（kg·d），每日晨顿服，血小板计数（PLT）正常后逐渐减量至停用。结果治疗14天，9例患者中完全反应（CR）4例，有效（R）4例，无效（NR）1例，总有效率为88．9％；其中4例PLT〈10×10^9／L者CR2例，5例PLT≥10×10^9／L者CR2例，两者疗效比较差异无统计学意义（P〉0．05）。9例患者治疗第2天PLT开始迅速上升但差异无统计学意义（P〉0．05），到第4天差异有统计学意义（P〈0．01）；第7天达峰值（P〈0．01）；治疗2周仍显著高于治疗前（P〈0．01）。患者主要不良反应为胃酸过多及血压轻度升高，经对症治疗可恢复。结论Dex冲击治疗继发于Graves病的重型免疫性血小板减少症提升血小板迅速，疗效肯定，不良反应小，既经济又实用，值得基层推广验证。Objective To observe the curative effect of dexamethasone（Dex）pulse therapy for treating severe im-mune thromhocytopenia secondary to Graves dlseases（GD）.Methods 9 patients with severe immune thrombocytope-nia secondary to GD were treated by Dex pulse therapy with 0.3-0.45 mg/（kg · d） of Dex with 0.9% diluted sodium chloride by intravenous injection for the first 3 days.On day 4,the dosage was reduced to 10 mg,while 1 mg/（kg · d） prednisone was given in place of Dex on day 5.All drugs were taken just once every morning.The dosage was reduced gradually and finally stopped after PLT reached to the normal level.Results After 14 days of treatment,4 cases had complete response（CR）and another 4 cases responsed（R）.Only 1 case failed the response.So the total effective rate was 88.9%.There were 2 CR cases in the 4 with PLT〈10× 10^9/L and 2 CR cases in the 5 with PLT≥10× 10^9/L,so there was no significant difference in the curative effects between the two （ P 〉0.05）.All the patients＇ PLT went up rapidly on the second day of the treatment, but the difference was not statistically significant（ P 〉0.05）.lt was not significantly different until day 4 （ P 〈0.01） and reached to the peak on day 7.Moreover,their PLT was still signifi-cantly higher than that before treatment after treating for 2 weeks （ P 〈0.01）.The main adverse effects included hy- perchlorhydria and lightly raise of blood pressure, both of which could recover after symptomatic treatment.Conclusion Dex pulse therapy severe immune thrombocytopenia secondary to GD can quickly increase PLT. It has positive cur-ative effect and is economical and practical with low incidence of adverse reactions.Thus, it is worth to be widely used and verified in primary hospitals.

关 键 词：地塞米松 冲击治疗 血小板减少症 免疫性 GRAVES病 

分 类 号：R554.6[医药卫生—血液循环系统疾病]