大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮继发血小板减少

目的　观察大剂量静脉滴注免疫球蛋白 (Iv Ig)在治疗系统性红斑狼疮 (SL E)继发血小板减少中的作用。方法　采用分组对照研究 ,对比不同治疗方案对 SL E继发血小板减少的疗效 :对照组口服 1mg/ (kg· d)强的松 静脉滴注 0 .8～ 1.0 g/ 3～ 4周环磷酰胺 ,其余 3组除给予相同剂量的强的松和环磷酰胺外 ,分别给予连续 3d的 Iv Ig(2 0 g/ d)、甲基强的松龙 (MP)冲击及 Iv Ig MP冲击。结果　 Iv Ig、MP冲击、Iv Ig MP冲击联用组血小板达高峰时间分别为 (6 .2± 4.4)、(7.3± 4.9)、(3.8± 2 .4) d,均较对照组 (31.0± 17.8) d明显缩短 (P<0 .0 1) ;Iv Ig MP冲击联用组血小板达高峰时间亦显著低于单纯 MP冲击组 (P<0 .0 5 )。Iv Ig、MP冲击、Iv Ig MP冲击 3组血小板计数峰值分别为 175 .1± 89.2、12 6 .8± 10 7.4及 12 8.4± 78.6 (× 10 9/ L) ,均显著高于对照组的 97.1± 6 1.3(×10 9/ L) (P<0 .0 5 )。结论　 Iv Ig对 SL E继发血小板减少有显著疗效 ,且与 MP冲击联用有协同治疗作用。

High Dose Intravenous Immunoglobulins in Treating Systemic Lupus Erythematosus-associated Thrombocytopenia

OBJECTIVE: To study the effect of high dose intravenous immunoglobulins(IvIg) in systemic lupus erythematosus (SLE)-associated thrombocytopenia. METHODS: A case-control study was undertaken to assess the effectiveness of different therapeutic regimens (oral prednisone, IvIg, bolus methylprednisolone(MP), and IvIg plus bolus MP) in improving SLE-associated thrombocytopenia. RESULTS: For SLE-associated thrombocytopenia, IvIg, bolus MP, and IvIg plus bolus IvIg significantly shorten the time to reach a peak platelet count, which was (6.2 +/- 4.4) days, (7.3 +/- 4.9) days, and (3.8 +/- 2.4) days respectively in comparison with oral prednisone, which was (31.0 +/- 17.8) days (P< 0.01); if high dose IvIg and MP in combination, the time was also shorter than bolus MP alone (P < 0.05). The elevation of platelet count in groups receiving IvIg, bolus MP, and IvIg plus bolus MP were significantly higher than as in group receiving oral prednisone therapy(P < 0.05). CONCLUSIONS: High dose IvIg is a useful therapy in improving SLE-associated thrombocytopenia.