霉酚酸酯治疗激素无效成人免疫性血小板减少症的临床研究  

Outcome of corticosteroid-resistant adult immune thrombocytopenia treated with mycophenolate mofetil

作　　者：王敏[1] 冯非儿[1] 王谦明 赵婷[1] 付海霞[1] 江倩[1] 江浩[1] 路瑾[1] 许兰平[1] 张晓辉[1] 

机构地区：[1]北京大学人民医院,北京大学血液病研究所,北京100044

出　　处：《临床血液学杂志》2016年第2期192-196,共5页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81470343);国家自然科学基金(No:81270643)

摘　　要：目的：探讨以霉酚酸酯（MMF）为主的方案治疗激素无效的成人免疫性血小板减少症（ITP）的疗效和安全性。方法：回顾性分析23例服用MMF（1.0~2.0g/d）治疗的激素无效成人ITP患者,观察疗效及毒副作用。结果：MMF治疗的总体有效率为73.9%（17/23）,其中6例（35.3%）完全缓解,11例（64.7%）部分缓解。MMF治疗中位起效时间为27（20~35）d,血小板计数升至峰值的中位时间为69（49~95）d。MMF治疗后,14例（82.4%）患者持续有效,随访时间为15.0（8.5~30.5）个月。MMF治疗有效患者的ITP病程明显短于MMF治疗无效患者的病程（P〈0.05）;MMF联合激素、环孢素或达那唑治疗的起效时间,明显短于MMF单药治疗的起效时间（P〈0.05）。23例患者服用MMF期间未发生严重并发症。结论：MMF对于激素无效的成人ITP有较好的疗效,且毒副作用小。Objective：To evaluate the efficacy and safety of mycophenolate mofetil（MMF）in the treatment of corticosteroid-resistant adult immune thrombocytopenia（ITP）.Method：The efficacy and toxicity of MMF（1.0 to 2.0g/d）in the treatment of 23 corticosteroid-resistant adult ITP patients were retrospectively analyzed.Result：The overall response rate was 73.9%（17/23）.Six（35.3%）patients achieved a complete response and 11（64.7%）patients achieved a partial response.The median time to response was 27（20 to 35）days.Peak platelet count was noted on a median of 69（49to 95）days.Fourteen（82.4%）patients sustained response after a median follow-up of 15.0（8.5 to 30.5）months.Patients who responded to MMF therapy had a shorter disease history than those who had no response（P〈0.05）.Patients treated with therapy combining MMF with corticosteroid,cyclosporine or danazol responded earlier than patients treated with MMF single therapy（P〈0.05）.No patients experienced severe complications during follow-up.Conclusion：MMF is effective for corticosteroid-resistant adult ITP patients with minor toxicity.

关 键 词：霉酚酸酯 糖皮质激素 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]