不同剂量丙种球蛋白治疗儿童免疫性血小板减少性紫癜的疗效分析

目的：分析不同剂量丙种球蛋白（IVIg）治疗儿童免疫性血小板减少性紫癜（ITP）的疗效，探讨有效、安全、经济的IVIg用量。方法回顾分析某院儿科自2005年2月至2014年2月收治的经不同剂量IVIg治疗的新诊断儿童ITP的临床资料。根据所用IVIg剂量的不同分为三组：小剂量（1.0g／kg）组、中剂量（1.5 g／kg）组、传统剂量（2.0 g／kg）组，分5 d应用。结果共入组病人98例，小、中、传统剂量组分别为30、35、33例。三组总反应率分别为96.67％、97.14％、100％（ P＝0.996），血小板（PLT ）升至30×109／L的中位时间分别为2.5、2.3、2.9 d（P＝0.355），组间差异均无统计学意义。三组患者的完全反应率分别为86.67％、88.57％、87.88％，差异无统计学意义（ P＝1.000）。结论减低剂量（1.0 g／kg或1.5 g／kg ）IV Ig与传统剂量（2.0 g／kg）IVIg比较，疗效相当、不增加慢性转化的风险，且更为经济节约，可被用来治疗新诊断儿童免疫性血小板减少性紫癜。

The efficacy of different dose intravenous immunoglobulin for the treatment of immune thrombocytopenia in children

Objective To compare the efficacy of intravenous immunoglobulin (IVIG) of different dosage in the treatment of paediatric immune thrombocytopenia (ITP) .Methods Children with de novo ITP treated with IVIG in our center from Febura‐ry 2005 to Feburary 2014 were included in this retrospective analysis .According to the dosage of IVIG ,Patients were classified into three groups :low‐dose group (1.0 g/kg) ,medium‐dose group (1.5 g/kg) ,and high‐dose group (2.0 g/kg) .Results Ninety‐eight patients were included in the study with 30 ,35 ,and 33 cases in low‐dose group ,medium‐dose group ,and high‐dose group ,respectively .There was no difference in the age of onset ,gender composition ,antecedent infection ,baseline platelet count ,and course among the three groups .The overall response rate (ORR) for each group was 96.67% ,97.14% ,and 100%(P=0.996) ,respectively .The median time for platelet counts rising to 30 × 109/L was 2.5 days ,2.3 days ,and 2.9 days (P=0.355) ,respectively .With a follow‐up of 12 months ,there was still no statistic diffrence in the complete response rate (CRR) among three groups with 86.67% ,88.57% ,and 87.88% for each group ,respectively .Conclusion Compared with IVIG of 2.0 g/kg ,the IVIG of lower dosage (1.0 g/kg or 1.5 g/kg) was more ecnomical ,had an equivalent efficacy without increasing risk of chronic transformation ,and thus could be used in the treatment of newly diagnosed ITP in children .