免疫性血小板减少症指南的解读
|
摘要
自美国医学会2011年发布免疫性血小板减少症指南以来,我国率先依据询证医学对免疫性血小板减少症指南进行更新。近几年有许多突破性的临床研究成果被公布,尤其是中国血液工作者为提高免疫性血小板减少症的治疗做出了突出的贡献,但目前尚缺少文献对于儿童、成人、老年、孕妇免疫性血小板减少症进行系统药物介绍,仍有部分患者对于一、二线药物治疗无反应。故本文结合文献对指南进行解读,探索各个治疗方案的优缺点,探讨临床治疗的瓶颈,方便指南的执行和理解,为及时更新下一版指南探路铺石。
Since the American Medical Association published the 2011 guidelines for immune thrombocytopenia,China has been the first to update the guidelines for immune thrombocytopenia based on evidence-based medicine.Recently, there have been many breakthroughs in clinical research published, especially the Chinese medical workers have made a prominent contribution to the treatment of the immune thrombocytopenia. However, the references of systematic drug introduction for children, adults, aged and pregnant women are still insufficient, and the first or second line treatment for some patients were ineffective. Therefore,we tried to combine the references to interpret the guidelines, to explore the advantages and disadvantages of each treatment, to find out the bottleneck of clinical treatment, so as to facilitate the implementation and understanding of the guidelines, then update the next guideline.
Since the American Medical Association published the 2011 guidelines for immune thrombocytopenia,China has been the first to update the guidelines for immune thrombocytopenia based on evidence-based medicine.Recently, there have been many breakthroughs in clinical research published, especially the Chinese medical workers have made a prominent contribution to the treatment of the immune thrombocytopenia. However, the references of systematic drug introduction for children, adults, aged and pregnant women are still insufficient, and the first or second line treatment for some patients were ineffective. Therefore,we tried to combine the references to interpret the guidelines, to explore the advantages and disadvantages of each treatment, to find out the bottleneck of clinical treatment, so as to facilitate the implementation and understanding of the guidelines, then update the next guideline.
引文
1 Rodeghiero F,Stasi R,Gernsheimer T,et al.Standardization of terminology,definitions and outcome criteria in immune thrombocytopenic purpura of adults and children:report from an international working group.Blood,2009;113(11):2386-2393.
2 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).中华血液学杂志,2016;37(2):89-93.
3 Neunert C,Lim W,Crowther M,et al.The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia.Blood,2011;117(16):4190-4207.
4 Mahevas M,Michel M,Godeau B.How we manage immune thrombocytopenia in the elderly.Br J Haematol,2016;173(6):844-856.
5 Brynes K,Orazi A,Theodore D,et al.Evaluation of bone marrow reticulin in patients with chronic immune thrombocytopenia treated with eltrombopag:Data from the EXTEND study.Am J Hematol,2015,90(7):598-601.
6 Fernandez-Pol S,Ma L,Ohgami RS,et al.Significance of myelodysplastic syndrome-associated somatic variants in the evaluation of patients with pancytopenia and idiopathic cytopenias of undetermined significance.Mod Pathol,2016;29(9):996-1003.
7 Hagihara M,Inoue M,Kodama K,et al.Simultaneous manifestation of chronic myelomonocytic leukemia and multiple myeloma during treatment by prednisolone and eltrombopag for immune-mediated thrombocytopenic purpura.Case Rep Hematol,2016;2016:2016;4342820.
8 Kenneth K,Marshall AL,Josef TP,et al.Williams hematology,9 th.Mc Graw-Hill New York,2015.
9 Jackson S,Beck PL,Pineo GF,et al.Helicobacter pylori eradication:novel therapy for immune thrombocytopenic purpura?A review of the literature.Am J Hematol,2005;78(2):142-150.
10 王立,陈华,钱敏,等.系统性红斑狼疮合并颅内静脉窦血栓的临床特点.中华临床免疫和变态反应杂志,2014;8(2):113-118.
11 Cheng Y,Wong RS,Soo YO,et al.Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone.N Engl J Med,2003;349(9):831-836.
12 Wei Y,Ji XB,Wang YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial.Blood,2016;127(3):296-302.
13 Alpogan O,Budak-Alpdogan T,Ratip S,et al.Efficacy of highdose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura.Br J Haematol,1998;103(4):1061-1063.
14 Kavanaugh A,Wells AF.Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis.Rheumatology(Oxford,England),2014;53(10):1742-1751.
15 Cuker A,Neunert CE.How I treat refractory immune thrombocytopenia.Blood,2016;128(12):1547-1554.
16 Khellaf M,Charles-Nelson A,Fain O,et al.Safety and efficacy of rituximab in adult immune thrombocytopenia:results from a prospective registry including 248 patients.Blood,2014;124(22):3228-3236.
17 Choi PY,Roncolato F,Badoux X,et al.A novel triple therapy for ITP using high-dose dexamethasone,low-dose rituximab,and cyclosporine(TT4).Blood,2015;126(4):500-503.
18 Sauvetre G,Mah Evas M,Limal N,et al.Cutaneous rash and dapsone-induced hypersensitivity syndrome a common manifestation in adult immune thrombocytopenia.Presentation and outcome in 16 cases.Am J Hematol,2015;90(10):E201-202.
2 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).中华血液学杂志,2016;37(2):89-93.
3 Neunert C,Lim W,Crowther M,et al.The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia.Blood,2011;117(16):4190-4207.
4 Mahevas M,Michel M,Godeau B.How we manage immune thrombocytopenia in the elderly.Br J Haematol,2016;173(6):844-856.
5 Brynes K,Orazi A,Theodore D,et al.Evaluation of bone marrow reticulin in patients with chronic immune thrombocytopenia treated with eltrombopag:Data from the EXTEND study.Am J Hematol,2015,90(7):598-601.
6 Fernandez-Pol S,Ma L,Ohgami RS,et al.Significance of myelodysplastic syndrome-associated somatic variants in the evaluation of patients with pancytopenia and idiopathic cytopenias of undetermined significance.Mod Pathol,2016;29(9):996-1003.
7 Hagihara M,Inoue M,Kodama K,et al.Simultaneous manifestation of chronic myelomonocytic leukemia and multiple myeloma during treatment by prednisolone and eltrombopag for immune-mediated thrombocytopenic purpura.Case Rep Hematol,2016;2016:2016;4342820.
8 Kenneth K,Marshall AL,Josef TP,et al.Williams hematology,9 th.Mc Graw-Hill New York,2015.
9 Jackson S,Beck PL,Pineo GF,et al.Helicobacter pylori eradication:novel therapy for immune thrombocytopenic purpura?A review of the literature.Am J Hematol,2005;78(2):142-150.
10 王立,陈华,钱敏,等.系统性红斑狼疮合并颅内静脉窦血栓的临床特点.中华临床免疫和变态反应杂志,2014;8(2):113-118.
11 Cheng Y,Wong RS,Soo YO,et al.Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone.N Engl J Med,2003;349(9):831-836.
12 Wei Y,Ji XB,Wang YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial.Blood,2016;127(3):296-302.
13 Alpogan O,Budak-Alpdogan T,Ratip S,et al.Efficacy of highdose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura.Br J Haematol,1998;103(4):1061-1063.
14 Kavanaugh A,Wells AF.Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis.Rheumatology(Oxford,England),2014;53(10):1742-1751.
15 Cuker A,Neunert CE.How I treat refractory immune thrombocytopenia.Blood,2016;128(12):1547-1554.
16 Khellaf M,Charles-Nelson A,Fain O,et al.Safety and efficacy of rituximab in adult immune thrombocytopenia:results from a prospective registry including 248 patients.Blood,2014;124(22):3228-3236.
17 Choi PY,Roncolato F,Badoux X,et al.A novel triple therapy for ITP using high-dose dexamethasone,low-dose rituximab,and cyclosporine(TT4).Blood,2015;126(4):500-503.
18 Sauvetre G,Mah Evas M,Limal N,et al.Cutaneous rash and dapsone-induced hypersensitivity syndrome a common manifestation in adult immune thrombocytopenia.Presentation and outcome in 16 cases.Am J Hematol,2015;90(10):E201-202.