难治性免疫性血小板减少性紫癜的治疗选择

目的通过临床对比选择一种治疗难治性免疫性血小板减少性紫癜的疗效确切的方法。方法将符合诊断标准的180例难治性免疫性血小板减少性紫癜患者按就诊顺序随机分为治疗组与对照组,每组90例。两组均给予泼尼松片1mg/kg.d,2次/d,口服,服用2周,然后逐渐减量维持至停用。治疗组在此基础上加用全反式维甲酸,每次10mg,每日3次,口服。两组均以4周为1个疗程,治疗1个疗程后观察疗效。结果治疗组治愈率为60.00%,对照组治愈率为40.00%,两组相比差异有统计学意义(P0.05)。治疗组总有效率为93.33,对照组的总有效率为80.00%,两组相比差异有统计学意义(P0.01)。CD4+CD25+T及CD4+CD25highT细胞表达水平治疗组治疗后低于对照组(P0.01),治疗组治疗前后有明显变化(P0.05),对照组治疗前后无明显变化(P0.05)。治疗后治疗组血小板上升情况、有效止血时间治疗组与对照组相比差异有统计学意义(P0.01)。结论使用全反式维甲酸治疗难治性免疫性血小板减少性紫癜可显著提高临床疗效,且具有副作用小,价格更低廉的特点。

Therapeutic Selection of Refractory Immune Thrombocytopenic Purpura

Objective To select a method of treating refractory immune thrombocytopenic purpura through comparing the clinical efficacy of two treatment methods.Methods According to registration order,180 patients with refractory immune thrombocytopenic purpura in accord with diagnostic criteria were randomly divided into treatment group and control group（each n=90）.The patients in the two groups were orally given prednisone tablets 1 mg/kg·d,2 times per day,taking 2 weeks and then gradually reducing the maintenance to the disabled.On this basis,treatment group was orally administrated all-trans retinoic acid,10 mg,3 times a day.The duration of treatment of the two groups was 4 weeks.The therapeutic effects were observed after the treatment.Results The curative rates of treatment group and control group were 60.00% and 40.00%,respectively;and the difference was statistically significant（P〈0.05）.The total effective rates of treatment group and control group were 93.33 and 80.00%,respectively;and the difference was statistically significant（P〈0.01）.After the treatment,CD4^＋CD25^＋T cells and CD4^＋CD25^highT cells in treatment group were lower than those of control group（P〈0.01）.There was a significant change in CD4^＋CD25^＋T cells and CD4^＋CD25^highT cells of treatment group between before and after the treatment（P〈0.05）,while no significant change was found in control group between before and after the treatment（P〉0.05）.After the treatment,there were statistically significant differences in the increase of blood platelet count and the effective bleeding-arrest time between treatment group and control group（P〈0.01）.Conclusions Using all-trans retinoic acid in treatment of refractory immune thrombocytopenic purpura can significantly improve the clinical efficacy,and with the advantages of less side effect and lower price.