抗-D免疫球蛋白与大剂量静脉丙种球蛋白治疗儿童急性特发性血小板减少性紫癜的meta分析

目的比较静脉注射抗-D免疫球蛋白（anti-D immunoglobulin,anti-D）与大剂量静脉注射免疫球蛋白（IVIG）治疗儿童急性特发性血小板减少性紫癜（ITP）的有效性及安全性。方法计算机检索PubMed、Embase和Cochrane Central Register of Controlled Trials。手工查阅计算机检索到的文献的参考文献目录。选取治疗72 h后血小板计数>20×109/L的百分率和血红蛋白下降值作为主要测量指标。采用RevMan 5.1对纳入文献进行meta分析。结果共检索到相关文献771篇,有5篇文献符合纳入标准。治疗72 h后anti-D组与IVIG组血小板计数>20×109/L比较差异有统计学意义（RR=0.90,95%CI：0.82～0.98）;亚组分析,anti-D 50μg/kg与IVIG比较,75μg/kg与IVIG比较,差异均无统计学意义（RR=0.98,95%CI：0.84～1.13;RR=0.88,95%CI：0.75～1.03）。anti-D组血红蛋白下降更明显,但患者均不需要输注悬浮红细胞。结论静脉注射anti-D治疗儿童急性ITP的疗效可能与大剂量IVIG相同。患者对anti-D的不良反应耐受性良好。     

糖皮质激素与静脉注射人免疫球蛋白治疗儿童原发性免疫性血小板减少症meta分析

目的分析糖皮质激素与静脉注射用人免疫球蛋白(IVIG)治疗儿童急性原发性免疫性血小板减少症(ITP)的有效性及安全性。方法计算机检索Pub Med、the Cochrane Database of Systematic Reviews、the Cochrane Central Register of Controlled Trials、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库,手工查阅计算机检索到的文献的参考文献目录,按照纳入与排除标准筛选文献,提取数据和评价纳入文献的质量,采用Revman 5.3软件进行meta分析。结果共检索到相关文献1 500篇,有8篇文献符合纳入标准。meta分析显示,治疗48 h后,糖皮质激素组与IVIG组血小板计数(PLT)??20×109/L的差异有统计学意义(RR=0.77,95%CI:0.67~0.89);亚组分析,甲基泼尼松龙(MP)30 mg/kg与IVIG 1 g/(kg·d)×2 d比较,泼尼松(PDN)4 mg/kg与IVIG 1 g/(kg·d)×2 d比较,差异均有统计学意义(RR=0.66,95%CI:0.47~0.91;RR=0.79,95%CI:0.66~0.95)。治疗24、72 h后,糖皮质激素组与IVIG组血小板计数??20×109/L比较,差异有统计学意义(RR=0.69,95%CI:0.53~0.91;RR=0.82,95%CI:0.74~0.90)。治疗24、48、72 h后糖皮质激素组与IVIG组血小板计数??50×109/L比较,差异有统计学意义(RR=0.38,95%CI:0.21~0.69;RR=0.53,95%CI:0.41~0.69;RR=0.80,95%CI:0.70~0.93)。糖皮质激素组与IVIG组脾切除发生率的差异无统计学意义(RR=5.41,95%CI:0.95~30.74,P=0.06)。结论接受糖皮质激素治疗的急性ITP患儿在初始治疗48 h达到血小板计数??20×109/L的概率较接受IVIG患儿低23%;以在前3天内将血小板计数提升到??50×109/L为初始治疗目标,IVIG的效果更好。     

静注免疫球蛋白及地塞米松对特发性血小板减少性紫癜患儿免疫功能的影响

探讨大剂量地塞米松 (DEX)及静注免疫球蛋白 (IVIG)治疗 ,对特发性血小板减少性紫癜 (ITP)患儿外周血 T淋巴细胞亚群及免疫球蛋白的影响 ,在以DEX、IVIG治疗 ITP患儿 ,治疗前后各抽血一次 ;以 APAAP法测定 T淋巴细胞亚群 ,以单向琼脂免疫扩散法测定免疫球蛋白。结果表明 1.ITP患儿外周血 CD4+ 降低 ,CD8+增高 CD4+ /CD8+ ,显著降低。单纯 DEX组治疗后 ,CD4+、CD8+均显著降低 ,CD4+ /CD8+升高 ,Ig A、Ig G、Ig M降低 ;单纯 IVIG组治疗后 ,CD8+显著降低 ,CD4+ /CD8+升高 ,Ig G显著升高。2 .单纯 DEX组治疗后 ITP患儿外周血白细胞计数显著高于治疗前 ,单纯 IVIG组与 IVIG加 DEX组治疗前后无显著差异。治疗过程中院内交叉感染率单纯 DEX组为 31.43% ,单纯 IVIG治疗组为 2 5 % ,IVIG加 DEX组为2 8.5 7%。因此 ,本文认为 ITP患儿外周血 T淋巴细胞亚群表达异常 ,IVIG及 DEX治疗均干扰了 ITP患儿机体的免疫状态     

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目的了解单次小剂量(0.4g/kg)静脉输注免疫球蛋白(IVIG)提升初发免疫性血小板减少性紫癜(ITP)患儿血小板至安全范围(≥30×109/L)的作用。方法研究对象为北京大学第一医院儿科2008-04-01—2011-04-01收治初发ITP患儿62例,其中2008-04-01—2009-10-01收治的30例为激素组,初始接受常规剂量醋酸泼尼松治疗;2009-10-02—2011-04-01就诊的32例为IVIG组,初始接受0.4g/(kg·d)IVIG治疗1～5d,每天复查血常规,血小板升至安全范围则规范停用。比较两组治疗第1、3、5天时血小板升至安全范围比例及长期随访结果。结果治疗前,激素组和IVIG组血小板中位值分别是10×109/L和6×109/L。治疗1d后两组血小板升至安全范围的比例分别是3.33%和43.75%,差异有统计学意义(P<0.01)。随访7～42个月后激素组和IVIG组分别有3.45%和3.23%血小板未升至正常(≥100×109/L)。所有患儿均无颅内出血发生及死亡。结论单次小剂量IVIG可使近半数初治ITP患儿血小板升至≥30×109/L相对安全范围,明显高于常规剂量醋酸泼尼松疗效。     

大剂量短疗程泼尼松治疗儿童急性免疫性血小板减少症的疗效观察

目的观察大剂量短疗程泼尼松(Pred)疗法对儿童急性免疫性血小板减少症(ITP)的疗效。方法 162例ITP患儿根据治疗方法不同随机分为大剂量静脉丙种球蛋白+甲基泼尼松龙组(IVIG+MP)、静脉丙种球蛋白组(IVIG)、甲基泼尼松龙组(MP)与Pred组。IVIG+MP组41例,采用IVIG(1g/kg,共1次)+MP[10 mg/(kg.d),每3天减半量,共9 d]冲击治疗,继之口服Pred[1.5～2.0 mg/(kg.d)],并逐渐减量维持治疗;IVIG组39例,采用丙种球蛋白(1 g/kg,共1次)冲击治疗,继之口服Pred[1.5～2.0 mg/(kg.d)]并逐渐减量维持治疗;MP组40例,采用MP[10 mg/(kg.d),每3天减半量,共9 d]冲击治疗,继之口服Pred[1.5～2.0 mg/(kg.d)]并逐渐减量维持治疗;Pred组42例,采用口服Pred[4 mg/(kg.d),共4 d]治疗后停药,无减量维持治疗。比较各组治疗前后血小板数、治疗有效率、不良反应发生率及药费支出。结果各治疗组治疗前后血小板数及治疗有效率差异无显著性,IVIG+MP组、IVIG组、MP组治疗不良反应发生率及药费支出均高于Pred组。结论大剂量短疗程Pred疗法治疗儿童急性ITP能有效提升血小板计数,有效率与IVIG及MP冲击治疗相比差异无显著性,不良反应少,花费低。     

不同剂量静脉免疫球蛋白治疗川崎病的临床及免疫学效应比较

目的评价应用静脉注射免疫球蛋白(IVIG)的不同治疗方案治疗川崎病(KD)的临床疗效及免疫学效应。方法 232例KD患儿随机分为3组:IVIG 1g/kg×1次组,IVIG 1g/kg×2次组,IVIG 2g/kg×1次组。对三种治疗方法的疗效进行前瞻性对比研究,观察患儿总热程、退热时间、黏膜充血、手足肿胀和颈部淋巴结肿大消退时间,监测外周血白细胞计数(WBC)、C反应蛋白(CRP)、血沉(ESR)、血浆纤维蛋白原(FIB)、冠状动脉病变(CAL)恢复情况,以及血清免疫球蛋白(Ig)、T、B淋巴细胞、自然杀伤(NK)细胞变化情况,并对治疗前后组内结果、治疗后组间结果进行比较。结果三组患儿治疗后的WBC、FIB、CRP、CD3、CD4、CD19细胞百分比、CD4/CD8较治疗前显著降低(P均<0.05),IgG、CD8、NK细胞百分比较治疗前显著升高(P均<0.05),ESR、IgA、IgM与治疗前比较,差异无统计学意义(P均>0.05);三组患儿治疗前的CAL发生率、WBC、FIB、CRP水平、CD3、CD4、CD19、CD8、NK细胞百分比、IgG水平、CD4/CD8差异无统计学意义(P均>0.05);治疗后三组患儿的临床症状恢复时间、CAL发生率、WBC、FIB、CRP水平、CD3、CD4、CD19、CD8、NK细胞百分比、CD4/CD8差异亦无统计学意义(P均>0.05);治疗后的IgG水平三组间差异有统计学意义,其中IVIG 1g/kg×2次组及IVIG 2g/kg×1次组均高于IVIG 1g/kg×1次组(P<0.05),IVIG 1g/kg×2次组与IVIG 2g/kg×1次组的差异无统计学意义(P>0.05)。结论 IVIG 1g/kg×1次治疗KD与IVIG 1g/kg×2次及IVIG 2g/kg×1次治疗的临床疗效及免疫学效应相当,其对冠状动脉的近期及远期保护效应相当,按照效益/价值比原则,IVIG 1g/kg×1次的治疗方法值得推荐。     

HD-MP与IVIG代替全血或血小板输注在抢救重度ITP中的疗效评价

探讨大剂量甲基强的松龙 (HD MP)冲击与静脉注射免疫球蛋白 (IVIG)两种方法替代全血或血小板输注在重度、极重度急性型特发性血小板减少性紫癜 (ITP)抢救中的价值。方法　对 36例入院时PLT≤ 18× 10 9 L、出血倾向明显的重度、极重度急性型ITP患儿随机分两组 ,Ig组 :IVIG 4 0 0mg kg·d ,连用 5天 ,接强的松 2mg kg·d口服 ;MP组 :MP 15- 30mg kg·d ,连用 3天 ,接强的松 2mg kg·d口服。连续监测治疗效果。结果　IVIG组用药 2 .1± 1.1天出血征开始减轻 ,5 .0± 1.9天PTL升至≥ 10 0× 10 9 L ,6 .7± 1.8天PTL达到峰值 334± 10 6× 10 9 L。MP组用药 5 .3± 1.5天出血倾向开始减轻 ,7.3± 2 .4天PLT升到≥ 10 0× 10 9 L ,10 .0± 2 .5天PLT达到峰值 199± 92× 10 9 L。两组三项指标均差异显著 (P <0 .0 1)。结论　在重度、极重度急性型ITP伴严重出血倾向患儿的抢救中 ,IVIG比HD MP冲击疗法升高PLT的作用更迅速、显著 ,是重度、极重度急性型ITP防治危及生命的严重出血代替血小板输注的较理想药物     

个体化剂量丙种球蛋白联合地塞米松治疗儿童重症特发性血小板减少性紫癜78例疗效观察

目的观察个体化剂量静脉注射用丙种球蛋白(IVIG)联合地塞米松治疗儿童特发性血小板减少性紫癜(ITP)的疗效。方法重症ITP患儿入院后均给地塞米松及IVIG[400 mg/(kg.d)],3 d后测外周血血小板计数,≥100×109/L停用IVIG,继用地塞米松;若<100×109/L,再继续用原剂量IVIG 2 d。结果治疗3 d后,78例患儿中,37例外周血血小板计数升至100×109/L以上,余41例继续治疗后,31例升至100×109/L以上。结论个体化剂量IVIG联合地塞米松是治疗儿童重症ITP的有效办法,可节省一定医疗费用。     

静脉用免疫球蛋白对脓毒症患儿免疫状态及转归的影响

目的 探讨静脉用免疫球蛋白(intravenous immunoglobulin,IVIG)对脓毒症患儿免疫状态以及转归的影响.方法 2008年8月至2010年4月入住我院儿童重症医学科符合脓毒症诊断的患儿84例,分为对照组(48例)和治疗组(36例),治疗组一次性输注IVIG l g/kg,分别于用药前(0 h)及用药后24h、72 h和5d抽取两组患儿外周静脉血,在流式细胞仪上进行免疫细胞(CD3+、CD4+、CD56+、CD19+、CD8+)计数,采用ELISA法检测细胞因子[肿瘤坏死因子-d(TNF-α)、白细胞介素(IL)-10、IL-17]水平并计算TNF-α/IL-10.比较两组患儿各时间点免疫细胞计数、细胞因子水平以及TNF-α/IL-10变化,并观察比较两组患儿28d病死率.结果 治疗组患儿CD3+、CD4+、CD56+、CD19+细胞计数,TNF-at、IL-17以及TNF-a/IL-10在应用IVIG后24h、72h、5d均明显低于对照组(P＜0.05),并且呈进行性下降趋势;而IL-10则明显增高(P＜0.05),呈上升趋势;CD8+细胞计数无明显变化.治疗组28 d死亡10例(27.7％,10/36),对照组死亡8例(16.6％,8/48),两组比较差别无统计学意义(x2=1.50,P=0.169,OR=1.92,95％ CI:0.671～5.510).结论 IVIG可使脓毒症患儿机体处于免疫麻痹状态,并不能提高存活率.     

X连锁血小板减少症临床特征及治疗的回顾性分析北大核心CSCD

目的 分析X连锁血小板减少症（XLT）患儿的临床特征及其对不同剂量和疗程激素、静脉注射免疫球蛋白（IVIG）治疗的应答情况.方法 回顾性分析重庆医科大学附属儿童医院2010年3月至2014年7月收治的15例XLT患儿的临床资料和诊治经过,包括血常规、免疫球蛋白、淋巴细胞分类、Wiskott-Aldrich综合征（WAS）基因及WAS蛋白检测结果,分别研究不同剂量和疗程的激素及IVIG提升血小板效果.结果 所有病例均符合XLT诊断标准,无或仅有轻微湿疹、感染表现.本组患儿血小板计数（8 ～80）×109/L,血小板体积5.6 ～10.9 fl（正常范围9.4～12.5 fl）.免疫球蛋白检测发现IgG升高5例,下降2例.14例行WAS基因检测突变类型均为错义突变包括4种热点突变（V75M、R86C、R86H、R86L）和1种新发突变（Y107C）.13例行WAS蛋白检测,6例无表达,5例表达减少,2例正常.14例患儿在确诊XLT前被诊断为免疫性血小板减少症（ITP）,使用激素（28例次）,IVIG治疗（47例次）.余1例未接受激素或IVIG治疗.IVIG治疗后2～7d及8～ 14 d,1000～2000 mg/（kg·d）组（25例次）血小板分别为（60±10）×10^9/L和（41±7）×10^9/L,400 ～ 500mg/（kg·d）组（22例次）血小板分别为（31±7）×109/L和（21±2）×10^9/L,两组相比差异均有统计学意义（Z=-4.419、-1.592,P=0.002、0.011）.激素治疗后2～7d及8～14d,1～2 mg/（kg·d）组（8例次）、3 ～6 mg/（kg·d）组（11例次）及20 ～ 30 mg/（kg·d）激素组（9例次）间提升血小板效果差异无统计学意义（F =0.387、0.252,P=0.980、0.761）.激素、IVIG治疗后15 ～ 30 d血小板均下降至接近治疗前水平.IVIG1 000～2000 mg/（kg·d）组的治疗有效率（18/25）明显高于400 ～ 500mg/（kg·d）组（2/22）,差异有统计学意义（x2=9.836,P=0.008）.激素20 ～ 30 mg/（kg·d）组治疗有效率（7/9）相对较高,但与1～2 mg/（kg·d）组（4/8）、3～6 mg/（kg·d）组（6/11）相比差异无统计学意义（χ^2 =3.235,P=0.581）.结论 XLT临床特征主要为血小板减少伴血小板体积减小,无或仅有轻微湿疹、感染表现.不同剂量激素治疗XLT患儿血小板减少的疗效无显著差异,1000～2000 mg/（kg·d）IVIG的疗效较显著,但均维持短暂.     

Intravenous immune globulin versus intravenous anti-D immune globulin for the treatment of acute immune thrombocytopenic purpura

Objective  The purpose of this study was to compare the efficacy and side effects of intravenous immunoglobulin (IVIG) with intravenous anti-D immunoglobulin for treatment of newly diagnosed acute childhood Idiopathic thrombocytopenic purpura (ITP). Methods  Children (6 months to 14 years) with newly diagnosed acute ITP and platelet count below 20,000/ μL were randomized to receive single dose intravenous 75 μg/kg anti-D or 1g/kg IVIG for two consecutive days (total dose 2 g/kg). Response rate defined as a platelet count over 20,000 / μL 72 hours after initial treatment. Results  Eighty one patients (52 male and 29 female) with mean age of 5 years and 3 months randomly divided in anti-D group (n=42) and IVIG group (n=39). Mean baseline (pretreatment) platelet counts were 15406 / μL and 15230/ μL in anti-D and IVIG group, respectively. The response rate in IVIG group (98%) was more significant than anti-D group (76%); (P = 0.017). After 7 days the platelet counts of all patients in IVIG group were more than 20,000/ μL while in anti-D group 12% had platelet counts below 20,000/ μL. Conclusion  In acute childhood ITP, initial treatment with IVIG (2g/Kg in divided dose) increased platelet count more rapidly and more significant than intravenous anti-D (single dose of 75 μg/Kg) within the first 72 hours.     

A cost-utility analysis of treatment for acute childhood idiopathic thrombocytopenic purpura (ITP)

BACKGROUND: The primary objective in the treatment of acute pediatric idiopathic thrombocytopenic purpura (ITP) is to rapidly increase the platelet count. METHODS: We built a decision analytic model to evaluate the cost-utility of four commonly used treatment strategies: intravenous immunoglobulin G (IVIG) 0.8 g/kg, anti-D 75 mcg/kg, methylprednisolone (30 mg/kg for 3 days), and prednisone (4 mg/kg/day for 4 days). In our baseline model, all children were hospitalized upon presentation, and discharged once the platelet count reached > or =20,000. We performed a literature search to estimate time to platelet count > or =20,000 for each strategy, as well as the probability of side effects. We obtained cost data and quality of life measures from institutional and published data sources. RESULTS: Total cost of one-time treatment for a 20 kg child was US dollars 786 with prednisone, US dollars 1,346 with methylprednisolone, US dollars 2,035 with anti-D, and US dollars 2,492 with IVIG. The strategies of IVIG and methylprednisolone were less effective and more expensive than anti-D and prednisone, respectively. Although anti-D caused the most rapid rise in platelet counts, the incremental cost-utility ratio (costs incurred by using anti-D instead of prednisone divided by health benefit of using anti-D instead of prednisone) was US dollars 7,616 per day of severe thrombocytopenia avoided, primarily due to the much higher medication cost of anti-D. Utilizing an outpatient model, the cost difference between anti-D and prednisone was even more striking. CONCLUSIONS: The clinical benefit of anti-D is offset by a substantial cost increase. Although often overlooked in favor of newer agents, a brief course of high-dose prednisone is an inexpensive and effective treatment for acute ITP.     

Randomized trial of high-dose methylprednisolone versus intravenous immunoglobulin for the treatment of acute idiopathic thrombocytopenic purpura in children

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by immune-mediated platelet destruction. The authors performed a prospective, randomized trial comparing intravenous immunoglobulin (IVIG) with high-dose intravenous methylprednisolone in the treatment of children with acute ITP. The primary aim of the study was to compare the rate of platelet increase produced by either intervention. A decision to treat was based on the clinical presentation and not an arbitrary platelet count. In general, enrolled patients exhibited extensive bruising and platelet counts less than 10 x 10 /L (10,000/microL). PATIENTS AND METHODS: Seventy-seven consecutive patients, for whom the attending hematologist determined acute treatment was warranted, were studied. Forty-two patients received IVIG (1 g/kg/dose x2) and 35 received methylprednisolone (30 mg/kg/dose x3). Patients who exhibited an increase in platelet count of more than 50,000/microL after the first IVIG dose or the second methylprednisolone dose did not receive the second IVIG dose or the third methylprednisolone dose, respectively. Patients' ages ranged from 6 months to 15 years. Platelet counts were evaluated at presentation, 24, 48, 72 hours, 1 week, and 2 to 4 weeks. RESULTS: Eighty percent of patients treated with IVIG and 60% of patients treated with methylprednisolone demonstrated an increase in platelet count of 50,000/microL or more within 48 hours. Both IVIG and methylprednisolone therapy increased platelet counts significantly above pretreatment values. In the methylprednisolone group, the mean baseline platelet count was 4,600/microL, which rose to 14,000/microL after 24 hours, 38,000/microL after 48 hours, and 65,000/microL after 72 hours. The IVIG group had a mean baseline platelet count of 4,200/microL, which rose to 32,000/microL after 24 hours, 69,000/microL after 48 hours, and 146,000/microL after 72 hours. When compared with methylprednisolone, IVIG therapy produced a greater rise in platelet counts at 24, 48, and 72 hours, with no difference at 1 week or later time points. No serious bleeding was noted in either treatment group. CONCLUSIONS: Both IVIG and methylprednisolone produce a significant early rise in platelet count that is somewhat greater with IVIG. However, the higher platelet counts produced by IVIG may not justify the additional cost and potential risks of this agent.     

Neutropenia following IVIG therapy in pediatric patients with immune-mediated thrombocytopenia

It has been observed that some children with immune-mediated thrombocytopenia (ITP) who are treated with intravenous immunoglobulin (IVIG) experience a decline in their absolute neutrophil count (ANC). The aim of this study was to investigate the incidence of neutropenia following IVIG therapy in a large cohort of children with ITP. This retrospective comparative cohort study determined the incidence of neutropenia in 104 patients (110 treatment courses) admitted for ITP to the Children's Hospital of Philadelphia from January 2000 to October 2003. Post-treatment ANCs were compared between patients who received IVIG and patients who received anti-D immunoglobulin. The incidence of neutropenia in each group was analyzed using the Fisher exact test. Pretreatment ANCs were not significantly different between the two treatment groups (P = 0.72). Neutropenia (ANC < 1,500/microL), developed during 18 of 64 (28%) treatment courses with IVIG, compared with 0 of 46 (0%) treatment courses with anti-D immunoglobulin (P < 0.001). This study suggests that IVIG may cause neutropenia commonly in children with ITP. While this is likely to be a transient condition, its recognition may affect clinical decisions such as the need for a bone marrow examination.     

Steroid-free interval with anti-D in chronic idiopathic thrombocytopenic purpura

Chronic idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by the antibody-mediated destruction of platelets. To maintain the platelets above the symptomatic level we administered 100 μg of anti-D for 5 consecutive days to 19 children with ITP. Four patients did not respond to the treatment. Fifteen responded with an increase in the average platelet number to 76 000/μL 7 days postinjection. However, the platelet count dropped within 45 days to 27 000/μL. Three months after this study, two patients from the study group were then administered monthly anti-D after reinjecting anti-D daily for 5 consecutive days, as previously performed. Platelet levels in these two patients were maintained above 30 000/μL for 5 and 6 months respectively. We concluded that anti-D administration for 5 consecutive days can induce an increase in platelets followed by a decrease below 30 000/μL after 30–45 days. However, monthly administration of anti-D after daily injections for 5 consecutive days can keep platelets above the symptomatic level and may provide a corticosteroid-free safe interval for nearly 5 months.     

A randomized and comparative study of intravenous immunoglobulin and mega dose methylprednisolone treatments in children with acute idiopathic thrombocytopenic purpura

The most common cause of mortality in childhood acute idiopathic thrombocytopenic purpura (ITP) is intracranial hemorrhage (ICH), which occurs in about 0.1% of children with platelet counts below 20,000/microl. Forty-two children (1-13 years) with ITP and platelet counts < or = 20,000/microl were randomly divided into two groups. Twenty patients received mega-dose methylprednisolone (MDMP) in a dosage of 30 mg/kg/d for three days and 20 mg/kg/d for four days. Twenty-two patients received intravenous immunoglobulin (IVIG) in a dosage of 1 g/kg/d two days. Platelet counts of the patients were determined at diagnosis, at 2, 4, 7, 14, 30, 60, 90, 120, 150, and 180 days and at three-month intervals after the 6th month. The mean platelet counts of both groups gradually increased and peaked on the 7th day (p > 0.05). There were no significant differences between the mean platelet counts of patients, in the two groups on treatment days 0, 2, 4, 7, and 14. The mean time for achievement of platelet counts above 20,000/microg in the MDMP group and the IVIG group was 4.1 and 2.9 days (p < 0.05) and above 50,000/microl was 5.0 and 5.2 days (p > 0.05), respectively. The percentages of patients with platelet counts above 20,000/microl at the 2nd day of the treatment were 50% in the MDMP group, and 86% in the IVIG group (p < 0.05). No significant differences were observed in the mean platelet counts of the two groups treatment days 30, 60, 90, 120 and 180 (p > 0.05). Chronic ITP developed in five patients (25%) in the MDMP group, and in four patients (18%) in the IVIG group (p > 0.05). Intravenous immunoglobulin (IVIG) (1 g/kg/d for 2 days) and MDMP treatments (30 mg/kg/d for 3 days, 20 mg/kg/d for 4 days, perorally) are equally effective in the treatment of acute ITP. Because of its nonbiologic source, lower cost, fewer side effects and oral use, we prefer oral preparations of MDMP in the treatment of childhood ITP.     

Efficacy and safety of anti-D for immune thrombocytopenic purpura in children

This study was conducted in 20 children (16 males) (mean age 9.2 ± 4.34y) with immune thrombocytopenic purpura (ITP) to assess the response to anti-D immunoglobulin. Six patients had newly diagnosed ITP, 6 had persistent ITP and 8 had chronic ITP. The overall response rate was 70% (14/20). The median time to response was 3 days (1–13 days). Response to anti-D was not related to age, sex, severity of bleeding, platelet counts at presentation, ABO blood group, or prior steroid or IVIG response.     

Anti-D immunoglobulin-induced prolonged intravascular hemolysis and neutropenia

Intravenous anti-D immunoglobulin (anti-D IVIG) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)-positive. Recent reports have described episodes of intravascular hemolysis after anti-D IVIG. We report an adolescent boy with chronic ITP who required multiple transfusions of erythrocyte suspensions when intravascular hemolysis persisted for 6 months after anti-D IVIG treatment. He did not have hemolytic anemia before treatment. The features of our case suggest that pediatric patients treated with anti-D IVIG for ITP should be closely monitored for signs and symptoms of hemoglobinemia and/or hemoglobinuria, and clinically significant anemia. Our case proposes that persistence of immune hemolysis after this treatment may be related to presence of previously defined predisposing agents like tuberculosis and antituberculous therapy. Our observations suggest that steroid therapy can be effective in patients who developed prolonged hemolytic anemia and neutropenia after anti-D IVIG therapy.     

静脉注射不同剂量丙种球蛋白治疗川崎病的临床研究

目的 评价静脉注射丙种球蛋白（intravenous immune globulin,IVIG）1g／kg单次静脉注射治疗川崎病（Kawasaki disease,KD）的临床效果。方法 242例KD患儿随机分为IVIG1s／kg组与IVIG 2g／kg组,对两种治疗方法的疗效进行前瞻性对比研究。分别采用IVIG 1g／kg和2s／kg单次静脉注射,观察患儿总热程、退热时间、黏膜充血、手足肿胀和颈淋巴结肿大消退时间,监测外周血白细胞计数（white blood cells count,WBC）、血小板计数（platelet count,PLT）、血清丙种球蛋白（immunoglobulin,Ig）、C反应蛋白（Creacting protein,CRP）、血沉（erythrocyte sedimentation rate,ESR）、心电图（electrocardiogram,ECG）和冠状动脉病变（coronary artery lesion,CAL）恢复情况,并对治疗前后组内结果、治疗后组间结果进行比较。结果 IVIG 1g／kg组平均热程为10．6d,WBC、PLT、CRP、ESR及ECG异常率与治疗前比较显著降低（P〈0．001）,IVIG1g／kg组与IVIG2g／kg组比较差异无统计学意义（P〉0．05）。WIG1g／kg组CAL发生率为29．5％（36／122）,随访1年有87．5％的CAL恢复正常,12．5％未能恢复正常,其中9．4％为IVIG耐药病例;IVIG2g／kg组CAL发生率为24．2％（29／120例）,随访1年有89．3％的CAL恢复正常,10．7％未能恢复正常,均为IVIG耐药病例,两组比较,差异亦无统计学意义（P〉0．05）。结论 IVIG1g／kg单次静脉注射治疗KD,可有效缓解临床症状,减低CAL发生率,减轻心血管系统损害,与IVIG2g／kg比较具有同样的近期和远期治疗效果。