血栓性血小板减少性紫癜患者的临床特征及预后评价  

Clinical characteristics and prognostic evaluation of patients with thrombotic thrombocytopenic purpura

作　　者：许琳蔚 陶红芳[1] 苏永忠[1] XU Lin-wei;TAO Hong-fang;SU Yong-zhong(Department of Hematology,the First Affiliated Hospital of Shantou University Medical College,Shantou Guangdong 515041,China)

机构地区：[1]汕头大学医学院第一附属医院血液一区,广东汕头515041

出　　处：《内科急危重症杂志》2022年第4期285-288,293,共5页Journal of Critical Care In Internal Medicine

摘　　要：目的:总结血栓性血小板减少性紫癜(TTP)患者的临床特征、治疗方式并分析其对预后的影响。方法:回顾性分析38例TTP患者的临床资料,按是否存活分为生存组和死亡组,比较2组患者的临床特征差异,治疗方式分为3种:支持治疗(成分输血、静脉免疫球蛋白等)、血浆置换、美罗华/硼替佐米联合血浆置换,利用Kaplan-Meier法比较不同治疗方式对预后的影响,并使用Cox回归模型分析对生存有独立影响的因素。结果:38例患者中,男性20例(52.6%),女性18例(47.4%),平均年龄(47.7±17.5)岁,存活及死亡各19例(50%)。生存组患者的年龄较死亡组小(P=0.03)。不同治疗方式对生存时间影响存在显著性差异(P=0.004),血浆置换组及美罗华/硼替佐米联合血浆置换组疗效明显优于单纯支持治疗组(P=0.034,P=0.008),而前2组间疗效比较,差异无统计学意义(P=0.48)。Cox回归模型结果表明,不同的治疗方式、乳酸脱氢酶水平可作为预后的独立预测因子。结论:以血浆置换为基础的治疗方式能够显著提高TTP患者的生存率,年龄较大或乳酸脱氢酶增高患者预后较差。Objective:To analyze the influence of clinical characteristics and treatment methods on prognosis of patients with thrombotic thrombocytopenic purpura(TTP).Methods:The clinical data of 38 TTP patients were retrospectively analyzed.There were three treatment options:supportive treatment(blood component transfusion and intravenous immunoglobulin);plasma exchange;plasma exchange in combination with Rituximab/Bortezomib.The differences in clinical features between survival and death groups were compared.Kaplan-Meier method was used to compare the effects of treatment methods on prognosis,and Cox regression model was used to predict the independent prognostic factors for survival.Results:Among38 TTP patients,20(52.6%)were males and 18(47.4%)were females,with an average age of 47.7±17.5 years.There were 19 survivors and 19 deaths.The average age of patients in the survival group was younger than in the death group(P=0.03).There were significant differences in survival time among different treatment regiments(P=0.004).There was significant difference between plasma exchange group or combined group and supportive group(P=0.034,P=0.008),but there was no significant difference between plasma exchange group and combined group(P=0.48).Cox regression model showed that different treatment regiments and lactate dehydrogenase(LDH)were independent prognostic factors.Conclusion:Treatment based on plasmapheresis can significantly improve the survival rate of TTP patients.The TTP patients with older age or higer LDH had a poor prognosis.

关 键 词：血栓性血小板减少性紫癜 血浆置换 乳酸脱氢酶 

分 类 号：R558.2[医药卫生—血液循环系统疾病]