丙种球蛋白联合糖皮质激素治疗儿童特发性血小板减少性紫癜疗效观察

目的观察丙种球蛋白联合糖皮质激素治疗儿童特发性血小板减少性紫癜(ITP)的临床疗效。方法 2015年1月至2016年5月湖南省儿童医院血液内科收治住院的ITP患儿80例,随机分为对照组和观察组各40例。对照组给予糖皮质激素治疗,观察组在对照组治疗基础上给予丙种球蛋白治疗,疗程均为21~28d。观察两组治疗疗效及血小板计数上升时间和血小板计数恢复正常时间。结果观察组总有效率95.0%(38/40),显著高于对照组77.5%(31/40),差异有统计学意义(P0.05)。观察组患儿血小板计数上升时间和血小板计数恢复正常时间均短于对照组,差异有统计学意义(P0.05)。结论 ITP患儿采用丙种球蛋白联合皮质激素治疗疗效显著。     

儿童特发性血小板减少性紫癜急性转慢性危险因素分析

目的　探讨影响小儿急性特发性血小板减少性紫癜（AITP） 发展成慢性特发性血小板减少性紫癜（CITP） 的危险因素。方法　选择2006年5月至2010年4月于广西医科大学一附院诊断AITP住院患儿138 例,对患儿临床表现、实验室检查、治疗方案等16个相关因素分别进行单因素成组对照研究。对有意义的单因素,再运用非条件Logistic 多因素回归模型分析,以期找到有意义的因素。结果　病程（患儿起病至治疗时间）、O Rh（D）+型血、用含有大剂量丙种球蛋白的治疗方案、血小板上升正常时间都是影响AITP患儿转为慢性的主要因素,而与发病年龄、治疗初用血小板、血小板开始回升时间、性别、有无前驱显性感染、治疗前血小板数、血小板平均体积、血小板平均分布系数、骨髓巨核细胞数、幼稚巨核细胞数、颗粒型巨核细胞数、有无幼稚淋巴细胞数无关。结论　AITP患儿早期治疗时用有大剂量丙种球蛋白的治疗方案是改善预后的关键,治疗时血小板回升正常时间晚、O Rh（D）+ 血型 （相对于A和B血型）是转为慢性的高危因素。     

特发性血小板减少性紫癜合并妊娠的临床分析

目的 探讨特发性血小板减少紫癜（ITP）合并妊娠的围产期处理方法。方法 回顾性分析我院1990－1999年间37例ITP合并妊娠的临床处理经验。结果 37例ITP孕妇中阴道分娩16例,剖宫产21例。与ITP有关的围产期并发症有产后出血及产褥感染,发生率分别为8．1％和2．7％。无孕产妇死亡。3例新生儿出现血小板减低,发生率为8．1％。无颅内出血发生。结论 ITP合并妊娠时,如不无科合并症,产妇以阴道分娩为宜;血小板水平极低的情况下,也可在血源充足时行选择性剖宫产;不主张使用干预性措施预防新生儿被动免疫性血小板减少症。     

小儿特发性血小板减少性紫癜35例回顾性分析

目的总结特发性血小板减少性紫癜（ITP）的临床特征。方法对35例小儿ITP的临床特征、诊断、治疗效果进行回顾性分析。结果 （1）ITP男女比例为1.33∶1;〈1岁者18例（51.43%）,〈3岁者28例（80.00%）。（2）18例（51.43%）ITP有前驱感染史,有7例检测血清肺炎支原体抗体,其中1例阳性;有疫苗接种者8例（22.86%）,年龄在4个月内的7例（87.50%）;最常见的临床特征是皮肤及黏膜下出血,重度出血3例（8.57%）。（3）23例（65.71%）骨髓穿刺检查结果提示巨核细胞成熟障碍。（4）肾上腺皮质激素为主或联合应用免疫球蛋白的治疗方案治疗小儿ITP疗效显著,差异无统计学意义（P〉0.05）。结论小儿ITP中婴幼儿的发病率高,大多数为急性型,预后良好;发病有多种因素;激素为主的治疗有效;动态观察血小板参数对其诊断和疗效观察有非常重要的意义。     

妊娠合并特发性血小板减少性紫癜1例报告

患者，29岁，因停经38周，鼻出血，牙龈出血，皮肤紫癜20余天于2000年7月16日入院。入院时主述头昏、乏力、食欲差、身体磕碰处容易出现紫癜。入院查体：T37．0℃，P120次／分，R20次／分，BP120／76mmHg。轻度贫血貌，口腔粘膜及牙龈出血，全身皮肤散在瘀点、瘀斑，双下肢浮肿( )。产科检查：宫底32cm，腹围100cm，胎位IDA，胎心146次／分，有不规律宫缩。     

妊娠合并特发性血小板减少性紫癜的诊治

近十年，对妊娠合并特发性血小板减少性紫癜(ITP)的认识有较深入的进展。新生儿出现中—重度血小板减少以及出血性并发症的几率并不高，但目前试图从众多病例中识别出少数将发生严重ITP的胎儿的无创和有创操作均不可靠，仍是期待解决的关键问题。剖宫产并不减少新生儿颅内出血的危险，建议只用于有产科指征的患者。     

中医治疗儿童慢性特发性血小板减少性紫癜的思路探讨

慢性血小板减少性紫癜是儿童时期比较常见的一种以出血和血小板减少为主要特征的疾病,治疗效果缓慢,且易复发。根据中医肾主骨生髓,肾藏精,精化血及“凡治血者,必先祛瘀为要”的理论,对于血小板减少性紫癜治疗既应该注重补肾,又要注意活血。基于上述认识并结合临床经验,确定了“益肾活血方”治疗本病,该方由熟地、菟丝子、仙灵脾、枸杞子、鸡血藤、土大黄、丹参、三七等药物组成。通过补肾生髓,祛瘀生新,调节免疫功能,减少血小板破坏,提升血小板数量,临床收到较好疗效。     

妊娠合并特发性血小板减少性紫癜40例临床分析

目的 探讨妊娠合并特发性血小板减少性紫瘢(idiopathic thrombocytopenic purpura，ITP)的诊断、处理及新生儿被动免疫性血小板减少症(neonatal passive immune thrombocytopenia，PIT)发生的相关因素。方法 回顾性分析我院1992年1月～2001年8月住院分娩的妊娠合并ITP孕妇及新生儿的临床资料。结果 妊娠合并ITP40例，发生率为3．4‰。其中妊娠合并妊高征7例，产后出血6例，早产5例，妊娠期糖尿病3例，胎儿生长受限3例。孕产妇死亡1例。阴道分娩13例，剖宫产27例。新生儿PIT9例，占28．1％，其中3例为重度PIT，新生儿颅内出血1例，围产儿死亡2例。新生儿PIT的发生与母体血小板计数、母体治疗情况及PAIgG水平无明显相关性。结论 妊娠合并ITP母儿预后较好，新生儿重度PIT发生率较低，颅内出血较少见。新生儿PIT的发生与母体治疗、母体血小板计数及PAIgG水平无明显相关性。     

妊娠合并特发性血小板减少性紫癜56例临床分析

<正>妊娠合并特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)是一种常见的自身免疫性血小板减少性疾病。因免疫性血小板破坏过多导致外周血血小板减少,是产科常见的血液系统合并症。血小板严重减少可致内脏出血、产后出血,甚至危及母体、胎儿生命。故妊娠合并ITP     

妊娠合并特发性血小板减少性紫癜的诊治

近十年,对妊娠合并特发性血小板减少性紫癜(ITP)的认识有较深入的进展.新生儿出现中-重度血小板减少以及出血性并发症的几率并不高,但目前试图从众多病例中识别出少数将发生严重ITP的胎儿的无创和有创操作均不可靠,仍是期待解决的关键问题.剖宫产并不减少新生儿颅内出血的危险,建议只用于有产科指征的患者.     

妊娠合并重度特发性血小板减少性紫癜的诊治

妊娠合并特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)是孕妇妊娠期间常见的血液系统疾病,临床表现以出血为主,贫血及感染风险轻度增加,ITP在整体上并不影响母儿结局,但会使出血的风险增加。本文重点就妊娠合并重度ITP的诊治、对母儿影响及孕期管理进行讨论。     

刘霞教授治疗小儿原发性血小板减少性紫癜的经验浅析

刘霞教授认为小儿原发性血小板减少性紫癜多由血热妄行及气阴两虚兼血瘀所致,临床主要以益气养阴,清热解毒,凉血化瘀为法,取得较好疗效。     

Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy

BACKGROUND: Idiopathic thrombocytopenic purpura commonly affects women of childbearing age and is associated with maternal and fetal complications. Management of a pregnant patient is difficult and requires combined care of obstetrician and a neonatologist. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last 7 years. METHOD: A retrospective study over the 7-year period 1997-2003 was carried out in the Department of Obstetrics and Gynaecology in the Postgraduate Institute of Medical Education and Research, Chandigarh, India. The course of pregnancy, disease and perinatal outcome of 19 pregnancies in 16 patients with idiopathic thrombocytopenic purpura was studied. RESULTS: Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Five patients diagnosed during pregnancy had severe thrombocytopenia, and four of them showed hemorrhagic manifestation. Nine patients required steroids during pregnancy. Two patients received immunoglobulin therapy. During the antenatal period one patient developed pre-eclampsia and one patient had gestational diabetes mellitus. Both of these patients were on steroids. There was no postpartum hemorrhage or maternal death. None of the neonates had bleeding complication, irrespective of mode of delivery. CONCLUSION: Pregnant patients with idiopathic thrombocytopenic purpura have generally good maternal and perinatal outcomes.     

妊娠合并特发性血小板减少性紫癜对母胎的影响及诊治

特发性血小板减少性紫癜（ITP）病因复杂,起病缓慢,因为临床表现与其他导致血小板减少的疾病类似,鉴别诊断困难,围产期处理较为棘手,如处理不当,可危及母胎生命。近年来,虽然对ITP的研究有了很大的进展,多个国家都制定了相应的指南及共识,但对于妊娠合并ITP的理想诊治策略仍存在一定争议。文章结合近年的文献着重介绍妊娠合并ITP的临床表现、对母胎的影响及其诊断、鉴别诊断和治疗进展。     

HELLP syndrome in a pregnant patient with a past history of splenectomy for idiopathic thrombocytopenic purpura. Case report

Case: We present a case of HELLP syndrome occuring in a patient who at the age of 8 years had undergone a splenectomy for idiopathic thrombocytopenic purpura. She was diagnosed as having HELLP syndrome 37 weeks of gestation and had a cesarean section. Received: 4 June 1996 / Accepted: 7 October 1996     

Prenatal evaluation of the platelet counts in the fetuses and the neonates of the mothers complicated with idiopathic thrombocytopenic purpura

We investigated 25 pregnancies with ITP. The results were as follows. 1. The platelet counts of the maternal blood just before delivery were not correlated with those of the cord blood. 2. It was suggested that the maternal PAIgG value just before delivery could foretell the onset of neonatal thrombocytopenic purpura. 3. The platelet counts in fetal scalp blood were correlated with those of the cord blood, but falsely lower platelet counts were found in the fetal scalp samples. 4. We saw 5 cases of percutaneous umbilical blood sampling (PUBS) in pregnancies with ITP. PUBS was found to be a useful and safe method. The indications for PUBS and fetal platelet transfusion in pregnancy with ITP are discussed.     

Intravenous gammaglobulin therapy in the management of a patient with idiopathic thrombocytopenic purpura and a warm autoimmune erythrocyte panagglutinin during pregnancy

Intravenous gammaglobulin (IVIgG) was recently introduced for the treatment of idiopathic thrombocytopenic purpura (ITP). Reported is a previously splenectomized patient who had a severe exacerbation of her ITP during pregnancy and was managed with large doses of IVIgG throughout the second half of her pregnancy. She also had an autoimmune IgG erythrocyte panagglutinin on her red blood cells and in her serum, but only minimal evidence of hemolysis. There was little or no transplacental passage of her autoimmune antibodies since she delivered a normal fetus after 34 weeks of gestation who had a normal platelet count and no evidence of an antierythrocyte antibody. Interestingly, at the time of delivery the mother's serum IgG was dramatically elevated, but the cord serum IgG was normal for the length of gestation, indicating the presence of a dramatic and abnormal difference in IgG between maternal and fetal blood. This raises the possibility that the IVIgG therapy may have actually prevented transplacental passage of the pathological antibodies.     

地塞米松联合丙种球蛋白治疗小儿过敏性紫癜性肾炎的疗效及对尿蛋白、尿红细胞的影响

目的观察地塞米松联合丙种球蛋白治疗小儿过敏性紫癜(HSP)性肾炎的疗效及对尿蛋白、尿红细胞的影响。方法选择2014年5月至2016年5月惠州市第一妇幼保健院儿科收治的90例HSP患儿为研究对象,随机分为观察组和对照组各45例。对照组采用地塞米松进行治疗,观察组采用地塞米松联合丙种球蛋白进行治疗。4周为1个疗程。观察两组临床疗效、治疗前后凝血指标、24h尿蛋白和尿红细胞水平及患儿不良反应情况。结果观察组治疗后总有效率为95.6%(43/45),显著高于对照组77.8%(35/45),差异有统计学意义(P0.05)。治疗4周后,两组凝血酶原时间较治疗前均无明显改变,差异无统计学意义(P0.05);两组部分凝血活酶时间显著高于治疗前,纤维蛋白原含量显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后部分凝血活酶时间值显著高于对照组,纤维蛋白原含量显著低于对照组,差异有统计学意义(P0.05)。治疗后,两组患儿24h尿蛋白、尿红细胞水平与治疗前比较均降低,差异有统计学意义(P0.05);观察组24h尿蛋白、尿红细胞水平显著低于对照组,差异有统计学意义(P0.05)。观察组不良反应发生率为4.4%(2/45),对照组不良反应发生率为6.7%(3/45),两组患儿不良反应发生率比较差异无统计学意义(P0.05)。治疗前和治疗4周时两组患儿肾损害发生率比较差异无统计学意义(P0.05)。治疗3个月后随访观察组失访1例,对照组肾损害发生率为28.9%(13/45),显著高于观察组11.4%(5/44),差异有统计学意义(P0.05)。结论地塞米松联合丙种球蛋白治疗小儿过敏性紫癜性肾炎效果确切,能够显著降低患者尿蛋白和尿红细胞水平,改善患儿肾功能,不良反应较少,值得临床推广。