卢瑜　林海清　孙雄飞

【摘要】 目的：观察与分析静脉滴注免疫球蛋白联合糖皮质激素治疗免疫性血小板减少症的临床疗效。方法：回顾性分析2013年1月-2017年12月本院收治的107例重症免疫性血小板减少症患者为对象进行研究，其中应用免疫球蛋白联合常规糖皮质激素治疗46例为观察组，应用常规剂量糖皮质激素治疗的重症免疫性血小板減少患者61例为对照组。比较两组出血停止时间、血小板达正常值的用时、住院天数、CR率及不良反应发生情况。结果：观察组出血停止时间、血小板达正常值的用时、住院天数、CR率与对照组比较均显著减少，差异均有统计学意义（P<0.05）。两组患者治疗期间不良反应发生率比较，差异无统计学意义（字2=1.002，P=0.285）。结论：针对重症免疫性血小板减少症患者采用免疫球蛋白联合糖皮质激素治疗的效果显著，即可显著改善患者血小板水平，快速止血，且减少各种不良反应，因而具有较高安全性，值得推广应用。

【关键词】 免疫性血小板减少症； 免疫球蛋白； 糖皮质激素

Clinical Efficacy of Immunoglobulin Combined with Glucocorticoids in Treatment of Immune Thrombocytopenia/LU Yu，LIN Haiqing，SUN Xiongfei.//Medical Innovation of China，2018，15（16）：-107

【Abstract】 Objective：To study and analyze the clinical efficacy of immunoglobulin combined with glucocorticoids in the treatment of immune thrombocytopenia.Method：A total of 107 patients with immune thrombocytopenia in our hospital from January 2013 to December 2017 were divided into control group（61 cases）and observation group（46 cases）by computer.The control group was treated with conventional dose glucocorticoids.On this basis，the observation group was treated with immunoglobulin.The bleeding cessation times，times of platelet to normal value，hospital stays，CR rates and adverse reaction rates were compared between the two groups.Result：The decrease degree of bleeding cessation times，times of blood platelet to normal value，hospital stays，CR rates in the observation group were lower than those in the control group，the differents were statistically significant（P<0.05）.There was no significant difference in the incidence of adverse reactions between the two groups during treatment（字2=1.002，P=0.285）.Conclusion：The effect of using immunoglobulin combined with glucocorticoid therapy for immune thrombocytopenia is very significant，which can significantly improve the platelet level of patients，quickly stop bleeding，reduce various adverse reactions，and thus has a higher safety.It is worthy of popularize.

【Key words】 Immune thrombocytopenia（ITP）； Immune globulin； Glucocorticoid

First-authors address：Shenzhen Peoples Hospital，Shenzhen 518020，China

doi：10.3969/j.issn.1674-4985.2018.16.031

在临床血液系统疾病中，原发免疫性血小板减少症（ITP）是一种常见的出血性疾病，目前无法根治。目前认为只有当外周血小板水平低于30×109/L，有出血症状或需进行手术才需临床积极干预。根据ITP的分期，重症ITP是指血小板低于10×109/L，且就诊时存在需要治疗的出血症状或常规治疗中发生新的出血症状，需要其他升高血小板药物治疗或需要增加原有的药物剂量。此类患者临床一线治疗方法主要为大剂量静脉输注免疫球蛋白和糖皮质激素[1-3]。其中采用免疫球蛋白大剂量输注可达到较高的疗效，且是紧急治疗有可能发生重要脏器或颅内致命出血的首选药物[4-6]。因此本文即对免疫球蛋白联合糖皮质激素治疗重症免疫性血小板减少症的临床疗效进行了分析，现报道如下。……