大剂量地塞米松治疗成人初治或复治原发性免疫性血小板减少症的Meta分析  

High-Dose Dexamethasone as A Initial- and Re-Treatment of Adult Patients with Primary Immune Thrombocytopenia: A Meta-Analysis

作　　者：倪蓓文[1] 钟璐[1] 殷婷玉[1] 陈芳源[1] 韩晓凤[1] 

机构地区：[1]上海交通大学医学院附属仁济医院血液科,上海200125

出　　处：《循证医学》2014年第5期277-284,共8页The Journal of Evidence-Based Medicine

基　　金：上海浦东新区卫生局重点协作资助项目(PW2012D-1)

摘　　要：目的探讨大剂量地塞米松治疗初治或复治原发性免疫性血小板减少症的疗效。方法通过文献检索收集2012年12月前公开发表的大剂量地塞米松治疗初治或复治原发性免疫性血小板减少症的研究,剔除不符合要求的文献,评价纳入研究的方法学质量,并提取有效数据进行Meta分析。结果符合纳入标准的文献13篇,共558例原发性免疫性血小板减少症患者。Meta分析结果显示：大剂量地塞米松治疗原发性免疫性血小板减少症患者,初治患者总反应率为82.2%（95%可信区间78.1%-85.7%）,完全缓解率为65.5%（95%可信区间58.9%-71.6%）;复治患者的总反应率为52.4%（95%可信区间43.1%-61.4%）,复治患者的完全缓解率为28.8%（95%可信区间21.2%-37.8%）。初治患者的长期反应率为59.5%（95%可信区间54.8%-64.2%）,复治患者的长期反应率为29.6%（95%可信区间20.4%-40.7%）。结论大剂量地塞米松对于初治原发性免疫性血小板减少症疗效佳,长期缓解率高,而对于复治患者疗效欠佳。Objective To evaluate the clinical effect of high-dose Dexamethasone as a initial- and re-treatment of adult patients with primary immune thrombocytopenia（ITP）. Methods We searched the electronic databases for the research of high- dose Dexamethasone as a treatment of patients with primary immune thrombocytopenia. All eligible literatures were assessed for quality. All data were performed by meta-analysis results.The deadline of the retrieval was December 2012. Rusults Thirteen studies involving 558 patients were included. The results of meta-analysis showed that the ORR of naive patients was 82.2%（95%CI 78.1%-85.7%）, the CR was 65.5%（95%CI 58.9%-71.6%）; the ORR of retreatment patients was 52.4%（95% CI 43.1% -61.4%）, the CR was 28.8%（95% CI 21.2% -37.8%）.Conclusion Initial patients may benefit from high doses of Dexamethasone, participating in its advantages of being accessible, and with few side effects. But the result of reteatment patients was not so good.

关 键 词：免疫性血小板减少症 大剂量地塞米松 初治 复治 

分 类 号：R558.2[医药卫生—血液循环系统疾病]