193例成人免疫性血小板减少症临床分析

目的总结193例成人免疫性血小板减少症（immune thrombocytopenia,ITP）患者的临床特点,分析ITP常用治疗方法的效果和疾病预后。方法回顾性分析首都医科大学附属北京朝阳医院1990年~2009年193例住院ITP患者的临床资料及治疗效果。结果 193例成人ITP患者中,22.8%的患者发病前有感染病史,79.3%的患者多表现为慢性病程。有出血表现者共167例（86.5%）,皮肤淤点、淤斑最多见（77.7%）,5例（2.6%）患者发生脑出血死亡。发生出血患者发病时血小板计数较未出血患者更低（P=0.000）。患者中166例（86.0%）使用了糖皮质激素或以糖皮质激素为基础的联合方案,115例（69.3%）出现治疗反应者。发病时血小板低于20×109/L,治疗效果较好（P=0.011）;女性患者疗效优于男性（P=0.029）;15~40岁较40岁以上患者疗效好（P=0.000）;有出血情况者较无出血者疗效好（P=0.004）;骨髓巨核细胞数量、抗核抗体（nuclear antibody,ANA）阳性与否和疗效无关。46例（23.8%）患者出现治疗相关不良反应,其中12例（6.2%）为转氨酶升高,12例（6.2%）血糖升高,1例（0.52%）因严重肺部感染死亡。结论成人ITP患者慢性过程多见,糖皮质激素仍然是ITP的首选治疗方法,患者性别、年龄和治疗前血小板数量有助于预测治疗效果。ANA阳性的ITP患者应该长期随访,其有可能转化为自身免疫性疾病。

Clinical characteristics of 193 adult patients with immune thrombocytopenic purpura

Objective To analyze the clinical manifestations and treatment effects of 193 adult patients with immune thrombocytopenic purpura（ ITP）. Methods Clinical features of 193 cases who suffered from ITP were retrospectively studied. Results Adult ITP patients were mostly（ 79. 3%） in chronic course. Some of them had a history of infection（ 22. 8%）; 86. 5% patients had a manifestation of hemorrhage. Petechiae and ecchymosis were the most common clinical symptoms in ITP patients（ 77. 7%）,5 patients（ 2. 6%） died of cerebral hemorrhage. The platelet count was lower in hemorrhage patients（ P = 0. 000） 0. 86% patients received glucocorticosteroid or glucocorticosteroid based combination regimen,69. 3% patients achieved a response. Platelet count less than 20 × 109/L,female,younger patients（ 15 ～ 40 years old） and the patients who had a manifestation of hemorrhage had a better response to the treatment（ P = 0. 011,0. 029,0. 000 and 0. 004,respectively）. Bone marrow megakaryocytes and serum ANA had no correlation with therapeutic effect（ P = 0. 054 and 0. 179,respectively）. 23. 8% patients developed side effects related to treatment,6. 2% had liver toxicity,and 6. 1% patients had an elevated blood glucose and 1 patient（ 0. 52%） died from severe lung infection. Conclusion Most of adult ITP patients were in chronic course. Glucocorticosteroid is still the first line treatment in ITP patients. Sex,age and platelet count may predict the treatment effects. The disease in ANA positive patients may become autoimmune disease as seen during a long period follow up.