丙种球蛋白联合糖皮质激素治疗儿童免疫性血小板减少症的疗效分析

目的 探讨丙种球蛋白联合糖皮质激素治疗儿童免疫性血小板减少症的疗效和安全性。方法 回顾性分析2008年1月~2018年1月在我院儿科住院治疗的72例免疫性血小板减少症的病例，按不同的治疗方案分为观察组（n=37）和对照组（n=35）。两组均给予抗感染、止血等对症治疗，对照组采用糖皮质激素治疗，观察组在对照组基础上联合丙种球蛋白治疗。比较两组患儿的治疗效果及预后，观察指标包括血小板计数、不良反应发生率、出血症状控制情况及3个月复发的情况。结果 观察组的总有效率为97.30%，高于对照组的82.90%，差异有统计学意义（P＜0.05）；两组治疗后各时间点血小板计数均有所提升，观察组提升幅度较对照组明显，差异有统计学意义（P＜0.05）；不良反应发生率，观察组与对照组对比（8.10% vs 5.70%），差异无统计学意义（P＞0.05）；出血症状消失时间的情况对比，观察组明显短于对照组，差异有统计学意义（P＜0.05）；3个月复发情况，观察组与对照组对比(2.70% vs 5.71%)，差异无统计学意义（P＞0.05）。结论 丙种球蛋白联合糖皮质激素治疗儿童免疫性血小板减少症，临床效果显著，起效快，显著缩短血小板提升时间，可有效控制出血，不良反应少，预后佳。

Therapeutic Effect of Gamma Globulin Combined with Glucocorticoid on Children with Immune Thrombocytopenia

Objective To investigate the efficacy and safety of gamma globulin combined with glucocorticoids in the treatment of immunological thrombocytopenia in children.Methods A retrospective analysis of 72 cases of immunological thrombocytopenia hospitalized in our hospital from January 2008 to January 2018 was divided into observation group (n=37) and control group according to different treatment regimens (n=35). Both groups were given symptomatic treatments such as anti-infection and hemostasis. The control group was treated with glucocorticoids, and the observation group was treated with gamma globulin on the basis of the control group. The therapeutic effects and prognosis of the two groups were compared. The indicators included platelet count, incidence of adverse reactions, control of bleeding symptoms, and recurrence at 3 months. Results The total effective rate of the observation group was 97.30%, which was higher than that of the control group 82.90%,the difference was statistically significant (P<0.05). The platelet counts were increased at each time point after treatment in the two groups. The increase in the observation group was significantly higher than that in the control group (P<0.05). The incidence of adverse reactions was compared between the observation group and the control group (8.10% vs 5.70%), the difference was not statistically significant (P>0.05); the time of bleeding symptoms disappeared, the observation group was significantly shorter than the control group, the difference was statistically significant (P<0.05); The recurrence of 3 months was compared between the observation group and the control group (2.70% vs 5.71%),the difference was not statistically significant (P>0.05).Conclusion The combination of gamma globulin and glucocorticoid in the treatment of immunological thrombocytopenia in children has a significant clinical effect, rapid onset, significantly shortening the time of platelet elevation, and can effectively control bleeding, with fewer adverse reactions and better prognosis.