曾雁玲　林哲耀　吴登蛟　王金钗

[摘要] 目的 观察大剂量地塞米松对成人免疫性血小板减少症患者的治疗效果和安全性。 方法 将48例初诊ITP患者随机分成两组，大剂量地塞米松治疗组24例，予地塞米松40mg/d，连用4d。间隔26d后重复1个疗程，以后不维持。常规剂量泼尼松治疗组24例，泼尼松1.0mg/（kg·d），早餐后顿服，连续用4周后逐渐减量。随访1年，观察两组的疗效及安全性，统计两组长期有效者的医疗费用。 结果 大剂量地塞米松治疗组有效率明显高于常规剂量泼尼松治疗组（83.33%与54.17%，x2=4.75，P<0.05）。地塞米松组达完全反应时间明显缩短，约1周左右出现反应，两组长期反应率相似（58.33%与45.83%，x2=0.75，P>0.05），地塞米松治疗组不良反应轻微，停药后恢复。泼尼松组不良反应较多。地塞米松治疗组医疗费用低。 结论 大剂量地塞米松治疗ITP疗效优于常规泼尼松，且安全性好，用药时间短，费用低。

[关键词]地塞米松；免疫性血小板减少症；泼尼松

[中图分类号] R558.2 [文献标识码] B [文章编号] 2095-0616（2015）24-198-03

[Abstract] Objective To observe the efficacy and safety of high dose dexamethasone as a therapy in adults immune thrombocytopenia（ITP）， compared with conventional dose prenisone therapy. Methods 48 newly diagnosed ITP patients were divided into 2 groups randomly.24 patients in the group of high dose dexamethasone treatments， dexamethasone 40mg/d for 4 days. Repeated after 26 days， and didn't maintain. The other 24 patients in the group of conventional dose prednisone treatments， prednisone 1.0mg/（kg.d）， after breakfast， for 4 weeks， then gradually reduced. To observe the efficacy and safety of the two groups for 1 year， analyze the medical cost of long-term effective patients in the two group. Results High dose dexamethasone treatment group efficiency was significantly higher than that of conventional dose prednisone treatment group （83.33% vs 54.17%，x2=4.75，P<0.05）. Dexamethasone group reached complete response time was significantly shortened， about 1 weeks to respond. The long time response rate of this two group was similar （58.33% vs 45.83%，x2= 0.75，P>0.05）.The adverse reactions of dexamethasone treatment group were mild， and recoverd after stopping the drug. The medical expence of dexamethasone treatment group was lower. Conclusion High dose DXM has an advantage in efficacy and safety than conventional dose prednisone，also in time and cost.

[Key words] Dexamethasone； Immune thrombocytopenia； Prednisone

成人免疫性血小板减少症（ITP）是一种获得性自身免疫性出血性疾病，是最常见的出血性疾病，也是血小板减少最常见的原因。各年龄阶段均可发病，60岁以上的老年人是该病的好发人群，男女比例为1∶2[1-2]。糖皮质激素是该病的首选药物，常规为泼尼松1.0mg/（kg·d），血小板计数升高达缓解后减量至维持剂量直至停药。如此使用糖皮质激素时间较长，副作用较大。目前一些学者亦开始使用大剂量地塞米松治疗该病。但国内对大剂量地塞米松治疗的疗效及安全性均在观察中。本研究采用随机方法比较连续2个疗程大剂量地塞米松和常规剂量泼尼松治疗成人ITP的疗效及安全性。……