老年原发免疫性血小板减少症诊治的研究进展

原发免疫性血小板减少症(ITP)以皮肤黏膜出血为起病时的主要临床表现,老年人是ITP的高发人群之一。目前尚无关于老年ITP的指南与专家共识。老年ITP作为成人ITP的特殊群体,在诊断、鉴别诊断及治疗等方面,既有与成人ITP的共性,也有其特殊性。老年ITP的治疗需要明确治疗目标并合理掌握启动治疗的时机,使血小板计数达到安全水平而不是正常水平。老年ITP的一线治疗方案包括糖皮质激素和免疫球蛋白,二线治疗方案包括促血小板生成素、利妥昔单抗、脾切除术等。老年ITP的治疗应遵循个体化原则,在最小化治疗措施不良反应的基础上提升血小板计数至安全水平,减少出血事件。

Progress in diagnosis and treatment of primary immune thrombocytopenia in the elderly

Primary immune thrombocytopenia(ITP)is an autoimmune disease manifested by dermorrhagia and muco?sal bleeding.The elderly is one of the high risk groups of ITP.There is no guideline or expert consensus on ITP for the el?derly up to date.As a special group of adult ITP,elderly ITP shares similarities with adult ITP in terms of diagnosis,differ?ential diagnosis and treatment,as well as its particularity.Treatment of ITP in the elderly requires a clear treatment target and a reasonable timing to start the treatment and the platelet count should reach a safe level rather than a normal level.The first-line treatment of elderly ITP includes glucocorticoids and immunoglobulin,and the second-line treatment in?cludes thrombopoietin,rituximab and splenectomy.Treatment of elderly ITP should follow the principle of individualiza?tion,increase the platelet count to a safe level and reduce bleeding events on the basis of minimizing adverse reactions of measures.