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

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英文篇名：A study on the effectiveness of high-dose dexamethasone in the treatment of children with immune thrombocytopenia 作者：祁海啸 ; 周国平 ; 胡剑 ; 周文娣 ; 洪泽 ; 张荣荣 ; 孙兴珍 ; 王春玲 ; 蒯文霞 英文作者：QI Haixiao;ZHOU Guoping;HU Jian;ZHOU Wendi;HONG Ze;ZHANG Rongrong;SUN Xingzhen;WANG Chunling;KUAI Wenxia;Department of Pediatrics,the First Hospital of Huai'an Affiliated to Nanjing Medical University; 关键词：大剂量地塞米松 ; 小儿 ; 免疫性血小板减少症 ; 疗效 英文关键词：high-dose dexamethasone;;children;;immune thrombocytopenia;;effectiveness 中文刊名：NJTD 英文刊名：Journal of Southeast University(Medical Science Edition) 机构：南京医科大学附属淮安第一医院儿科; 出版日期：2019-04-25 出版单位：东南大学学报(医学版) 年：2019 期：v.38;No.174 基金：国家自然科学基金资助项目(31640048);; 淮安市科技计划社会发展项目(HAS201608) 语种：中文; 页：NJTD201902008 页数：4 CN：02 ISSN：32-1647/R 分类号：59-62

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)×10~9L~(-1)、两周后的血小板数为(212.31±85.26)×10~9L~(-1)、4周后的血小板数为(181.72±69.68)×10~9L~(-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)×10~9L~(-1)、(163.58±65.82)×10~9L~(-1)、(116.43±49.75)×10~9L~(-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)×10~9L~(-1)after one week treatment,(212.31±85.26)×10~9L~(-1)after two weeks treatment,and(181.72±69.68)×10~9L~(-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)×10~9L~(-1),(163.58±65.82)×10~9L~(-1),(116.43±49.75)×10~9L~(-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.

引文

[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]GOMEZ-ALMAGUER D,HERRERA-ROJAS M A,JAIME-PREZ 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.