30例血栓性血小板减少性紫癜临床分析

目的 探讨血栓性血小板减少性紫癜（thrombotic thrombocytopenic purpura，TTP）患者的临床特征、治疗方案及预后，以提高TTP诊疗水平。方法 回顾性分析2012年4月至2018年12月住院的30例TTP患者的临床表现、实验室检查、治疗及预后。结果 30例TTP患者中男性14例，女性16例，平均年龄（51.33±14.88）岁，三联征17例（57%），五联征11例（37%）；加重2例，复发2例，难治1例，死亡16例（53%）；24例（80%）患者行血浆置换，血浆置换组与非血浆置换组之间病死率差异有统计学意义（P<0.05）；血浆置换次数≤ 4次与血浆置换次数>4次者病死率差异无统计学意义（P>0.05）；血浆置换前后血红蛋白、血小板、乳酸脱氢酶值，差异有统计学意义（P<0.05）。结论 TTP诊断需要依据临床表现及实验室检查，血浆置换可显著降低TTP患者病死率，对于明确诊断后的患者应尽早应用。

Clinical analysis of thrombotic thrombocytopenic purpura in 30 cases

Objective To investigate the clinical features, treatment regimen and prognosis of patients with thrombotic thrombocytopenic purpura (TTP), and to improve the level of TTP diagnosis and treatment. Methods The clinical manifestation, laboratory examination, treatment and prognosis of 30 patients with TTP hospitalized in our hospital from April 2012 to December 2018 were analyzed retrospectively.Results Among the 30 TTP patients, there were 14 males and 16 females, with an average age of (51.33±14.88)years, 17 with triad (57%), 11 with pentad (37%);2 with exacerbation, 2 with recurrence, 1 with refractory, and 16 with death (53%). Twenty-four patients were performed plasma exchange, and there was statistically significant difference in mortality between the plasma exchange group and the non-plasma exchange group (P<0.05).There was no statistically significant difference in mortality between the number of plasma exchange less than or equal to 4 times and the number of plasma exchange>4 times (P>0.05). There were statistically significant differences in hemoglobin, platelet and lactate dehydrogenase values before and after plasma exchange (P<0.05).Conclusion TTP diagnosis needs to be based on clinical manifestations and laboratory examination. Plasma exchange can significantly reduce the mortality of TTP patients, and should be applied as soon as possible after diagnosis.