免疫性血小板减少症125例临床分析

本研究旨在探讨免疫性血小板减少症(ITP)患者的临床特点。回顾性分析125例于2005年1月-2010年5月在我院住院治疗的ITP患者的临床资料、实验室检查结果及治疗效果。结果表明,125例患者发病中位年龄41岁,男女比为1∶1.78;治疗前平均血小板计数(28.59±23.05)×109/L;69.1%(67/97)的患者有风湿免疫检查异常;肝炎病毒和细小病毒B19携带率分别为37.3%(22/59)和44.8%(26/58);慢性患者CD3+T细胞为(62.7%±14.11%),在急性患者为(55.44%±14.31%)。慢性患者CD19+B细胞为(12.83%±6.96%),在急性患者为(19.47%±6.93%);91例患者行骨髓细胞膜抗体检查显示,54.9%(50/91)的患者抗体阴性,45.1%(41/91)患者抗体阳性;急性患者阳性率63.0%(17/27),在慢性患者为37.5%(24/64);激素联合环孢素治疗有效率为81.7%(49/60),部分难治性患者对RCP化疗或硫唑嘌呤细胞毒药物治疗的有效率分别为57.14%(4/7)和40.0%(2/5)。结论:ITP患者常合并病毒感染或风湿免疫学异常,急性患者以体液免疫功能亢进为主,慢性患者则表现为细胞免疫功能亢进;骨髓细胞膜抗体阳性的患者多是急性患者,因此在治疗方案的选择上应根据不同的发病机制选择不同作用机制的药物或药物组合,以取得更好的疗效。

A Clinical Analysis of 125 Cases of Immune Thrombocytopenia

This study was aimed to investigate the clinical features of patients with immune thrombocytopenia（ITP）.The clinical data,laboratory results and therapeutic effects of 125 inpatients with ITP from January 2005 to May 2010 were retrospectively analyzed.The results showed that median age of 125 inpatients was 41,and the sex ratio of male to female was 1∶1.78.The average pre-treatment platelet count was（28.59 ± 23.05） ×109/L.69.1% patients（67/97） suffered from rheumatoid or immune abnormalities.The carrier rate of hepatitis B virus and parvovirus B19 were 37.3%（22/59） and 44.8%（26/58） respectively.CD3＋T cells in chronic patients was（62.7%±14.11%）,while that in acute patients was（55.44%±14.31%）.The rate of CD19＋B cells in chronic patients was（12.83%±6.96%）,that was（19.47%±6.93%） in acute patients.91 patients were subjected to the examination for bone marrow mononuclear cell membrane antibody,with 54.9%（50/91）cases negative and with 45.1%（41/91）cases positive.63.0%（17/27）acute patients were positive,while that was 37.5%（24/64） in chronic patients.Therapy of hormone combined with cyclosporine showed efficiency of 81.7%（49/60）,the response of some refractory patients to RCP chemotherapy or azathiopurine cytotoxic drugs showed efficiency of 57.14%（4/7） and 40.0%（2/5） respectively.It is concluded that patients with ITP always accompany with virus infection or rheumatism abnormalities.Acute patients always accompany with hyperfunctioning of humoral immune,while the chronic ones were with hyperfunctioning of the cellular immune.Patients with positive bone marrow mononuclear cell membrane antibody are more likely to be acute.In order to obtain a better effect,the treatment strategies should be based on different pathogenesis to choose different drugs or different combinations of medicine.