老年重症原发免疫性血小板减少症特征及疗效的临床分析  

Clinical Analysis of Characteristics and Efficacy in Elderly Patients with Primary Immune Thrombocytopenia

作　　者：余孟莹 潘凌霄 毛静诚 柴古凡 朱剑锋 夏园 YU Meng-ying;PAN Ling-xiao;MAO Jing-cheng;CHAI Gu-fan;ZHU Jian-feng;XIA Yuan(The Affiliated Taizhou People’s Hospital of Nanjing Medical University;Taizhou School of Clinical Medicine,Nanjing Medical University,Taizhou Jiangsu 225300,China)

机构地区：[1]南京医科大学泰州临床医学院,南京医科大学附属泰州人民医院血液科 [2]南京医科大学泰州临床医学院,南京医科大学附属泰州人民医院全科医学科,江苏泰州225300

出　　处：《泰州职业技术学院学报》2025年第2期64-68,共5页Journal of Taizhou Polytechnic College

基　　金：南京医科大学泰州临床医学院基础研究项目(TZKY20230106,项目主持人:夏园);南京医科大学附属泰州人民医院院级科研基金项目(ZL202203,项目主持人:夏园);江苏省自然科学基金项目(BK20241119,项目主持人:夏园).

摘　　要：目的探究老年重症原发免疫性血小板减少症(ITP)的临床特点和不同用药方案的疗效。方法回顾性分析2015年1月至2022年12月期间南京医科大学附属泰州人民医院血液科诊治的120例重症ITP患者,根据年龄将患者分为老年组(≥60岁)与非老年组(<60岁),比较两组患者的前驱感染、病程、合并症、出血评分、疗效等临床特征。根据患者所使用的治疗方案,比较激素单药(激素单药)、激素联用静注人血丙种球蛋白(激素+丙球)、激素联用重组人血小板生成素(激素+rhTPO)对老年重症患者的短期疗效,并进行成本—效果分析。结果本研究共纳入120例患者,含老年患者77例、非老年患者43例。与非老年组比较,老年组男性、合并高血压或糖尿病、出血评分≥5分的比例均更高,而前驱感染率更低(P<0.05)。老年患者血小板计数在用药第3天、第5天、第7天及出院前均低于非老年患者;老年患者的血糖升高和总不良反应发生率均高于非老年患者(P<0.05)。激素+丙球组在用药d5和d7的总有效率显著高于激素单药组(P<0.05),两种联合方案总有效率差异无统计学意义。激素+rhTPO组的增量成本与增量效果比值低于激素+丙球组(P<0.05)。结论老年患者为ITP主要发病人群。与非老年患者相比,老年患者易发生严重出血、治疗后起效慢,且不良反应发生率高。激素与rhTPO联用是老年重症ITP中兼具有效性与经济性的方案。Objective To explore the clinical characteristics of elderly patients with primary immune thrombocytopenia(ITP)and the efficacy and cost-effectiveness ratio of different treatment regimens.Methods Patients with newly diagnosed severe ITP admitted to the Department of Hematology in the Affiliated Taizhou People's Hospital of Nanjing Medical University from January 2015 to December 2022 were retrospectively enrolled in this study.Patients were divided into elderly(≥60 years old)and non-elderly(<60 years old)groups.We compared the clinical characteristics such as preceding infection,course of illness,complications,bleeding scores,treatment efficacy,etc.,between two groups of patients.Additionally,we conducted an analysis of the short-term efficacy and cost-effectiveness of three commonly used treatment regimens:glucocorticoid monotherapy,glucocorticoids combined with intravenous immunoglobulin(glucocorticoid+IVIg),and glucocorticoids combined with recombinant human thrombopoietin(glucocorticoid+rhTPO),in elderly patients with severe ITP.Results A total of 120 patients were included this study,including 77 elderly patients and 43 non-elderly patients.Compared to the non-elderly group,the proportion of males,individuals with concomitant hypertension or diabetes,and those with a bleeding score≥5 were all higher in the elderly group,while the preceding infection rate was lower(P<0.05).Platelet counts in elderly patients were lower than those in non-elderly patients on medication days 3,5,7,and before discharge;elderly patients had higher rates of elevated blood sugar and overall adverse reaction occurrence compared to non-elderly patients(P<0.05).The total effective rates on days 5 and 7 after medication in the glucocorticoid+IVIg group were significantly higher than those in the glucocorticoid monotherapy group(P<0.05).There was no statistical difference in the total effective rates between the two combination therapy regimens,and the incremental cost-effectiveness ratio of the glucocorticoid+rhTPO group was lower

关 键 词：原发免疫性血小板减少症 老年 糖皮质激素 重组人血小板生成素 

分 类 号：R558.2[医药卫生—血液循环系统疾病]