大剂量地塞米松治疗小儿免疫性血小板减少症的临床研究-东南大学学报医学版

大剂量地塞米松治疗小儿免疫性血小板减少症的临床研究

单位：南京医科大学附属淮安第一医院儿科, 江苏淮安 223300

分类号：R720.5;R725.5

出版年·卷·期（页码）：2019·38·第二期（255-258）

摘要：

目的：探讨大剂量地塞米松治疗小儿免疫性血小板减少症（ITP）的临床疗效。方法：将60例初诊ITP患儿随机分为治疗组和对照组（各30例），治疗组用大剂量（1 mg·kg^-1·d^-1）地塞米松静脉滴注，对照组用常规剂量（0.25 mg·kg^-1·d^-1）地塞米松静脉滴注，比较两组患儿的血小板恢复情况、总有效率及不良反应。结果：治疗组的血小板开始上升时间为（2.95±1.32）d、血小板恢复正常所需时间为（5.86±2.46）d、治疗1周后的血小板数为（152.26±65.73）×10⁹L^-1、两周后的血小板数为（212.31±85.26）×10⁹L^-1、4周后的血小板数为（181.72±69.68）×10⁹L^-1，均优于对照组[对应数值分别为（5.32±2.65）d、（8.53±3.32）d、（85.72±40.68）×10⁹L^-1、（163.58±65.82）×10⁹L^-1、（116.43±49.75）×10⁹L^-1]，差异有统计学意义（P<0.05）。治疗组的总有效率（86.67%）高于对照组（63.33%），差异有统计学意义（P<0.05）。治疗组中有1例患儿出现高血压副作用，对照组中未出现副作用，两者差异无统计学意义（P>0.05）。结论：大剂量地塞米松治疗小儿初诊ITP的疗效比常规剂量地塞米松更显著，两者不良反应均轻微，安全性较好。

Objective:To investigate the effectiveness of high-dose dexamethasone on children with immune thrombocytopenia (ITP). Methods:60 cases of newly diagnosed ITP were randomly divided into two groups, the treatment group with high-dose dexamethasone 1 mg·kg^-1·d^-1 treatment, the control group with routine dose of dexamethasone 0.25 mg·kg^-1·d^-1 treatment. The platelet recovery, total effective rate and adverse reactions were compared between the two groups. Results:In the treatment group, the time were (2.95±1.32) days when platelet began to rise;the time were (5.86±2.46) days when platelet count returned to normal;the platelet counts were (152.26±65.73)×10⁹L^-1 after one week treatment,(212.31±85.26)×10⁹L^-1 after two weeks treatment, and (181.72±69.68)×10⁹L^-1 after four weeks treatment,which were better than those of the control group[the corresponding values were (5.32±2.65) days, (8.53±3.32) days, (85.72±40.68)×10⁹L^-1, (163.58±65.82)×10⁹L^-1, (116.43±49.75)×10⁹L^-1].The differences were statistically significant (P<0.05).The total effective rate (86.67%) of the treatment group was higher than that of the control group (63.33%) and the difference was statistically significant (P<0.05). One patient occured hypertension as a side effect of hormone in the treatment group while no side effect in the control group, and the difference was not statistically significant (P>0.05). Conclusion:The effectiveness of high-dose dexamethasone in the treatment of children with newly diagnosed ITP is more remarkable than that of conventional dose dexamethasone. Both have slight adverse reactions and good safety.

参考文献：

[1] ARNOLD D M.Bleeding complications in immune thrombocytopenia[J].ASH Education Program Book,2015,2015(1):237-242.
[2] 杜娟,钱晓萍,胡文静,等.健择化疗后免疫机制介导的血小板减少症[J].现代医学,2007,35(4):325-326.
[3] 杨敏,刘文君.免疫性血小板减少症发病机制研究最新进展[J].中国实验血液学杂志,2016,24(3):958-962.
[4] 谢晓恬.儿童免疫性血小板减少症发病机制与诊治研究进展[J].中国小儿血液与肿瘤杂志,2017(1):51-54.
[5] 郭宏岗,沈建良.原发免疫性血小板减少症发病机制的研究进展[J].山东医药,2016,56(11):96-99.
[6] WEI Y,JI X,WANG Y,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial[J].Blood,2016,127(3):296-302.
[7] GÓMEZ-ALMAGUER D,HERRERA-ROJAS M A,JAIME-PÉREZ J C,et al.Eltrombopag and high-dose dexamethasone as frontline treatment for newly diagnosed immune thrombocytopenia in adults[J].Blood,2014,123(25):3906-3908.
[8] 中华医学会儿科学分会血液学组.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志,2013,51(5):382-384.
[9] 董永超,李建琴.原发性免疫性血小板减少症的诊治研究进展[J].国际免疫学杂志,2016,39(5):510-513.
[10] 中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89-93.
[11] MAZZUCCONI M G,FAZI P,BERNASCONI S,et al.Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura:a GIMEMA experience[J].Blood,2007,109(4):1401-1407.
[12] MA J,FU L L,CHEN Z P,et al.Clinical study of pulsed high-dose dexamethasone treatment in 38 children with primary immune thrombocytopenic purpura[J].Chinese Journal of Hematology,2016,37(10):912-915.
[13] 万小梅.大剂量地塞米松治疗儿童原发免疫性血小板减少症临床分析[J].皖南医学院学报,2017,36(3):240-242.
[14] LI J,WANG Z,HU S,et al.Correction of abnormal T cell subsets by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura[J].Immunol Lett,2013,154(1-2):42-48.
[15] HOU Y,FENG Q,XU M,et al.High-dose dexamethasone corrects impaired myeloid-derived suppressor cell function via Ets1 in immune thrombocytopenia[J].Blood,2016,127(12):1587-1597.
[16] LIU Z,WANG M,ZHOU S,et al.Pulsed high-dose dexamethasone modulates Th1-/Th2-chemokine imbalance in immune thrombocytopenia[J].J Transl Med,2016,14(1):301.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录