特发性血小板减少性紫癜2种治疗方案比较及经济学评价

目的探讨70例特发性血小板减少性紫癜(ITP)患儿中2种治疗方案的临床疗效及经济学评价。方法对静脉用丙种球蛋白(IVIG)与地塞米松(GC)静脉联合治疗组及单用GC治疗组进行回顾性分析,并应用成本-效果分析法进行临床经济学评价。采用SPSS 14.0软件进行统计学分析。结果 2组ITP患儿治疗后不良反应、回访情况比较差异均无统计学意义。IVIG+GC组PLT下降极重度(10～25)×109L-1]、重度(<10×109L-1)、严重出血例数均高于GC组。2组治疗第1-7天PLT上升至正常天数比较,有效率、显效率比较,IVIG+GC组均优于GC组。应用成本-效果法分析GC组相对优于IVIG+GC组。结论对于重度、极重度、出血程度严重的ITP患儿主张选择IVIG+GC治疗;对于轻、中度病例则可选择GC治疗。临床治疗的选择应综合考虑,既要考虑临床疗效,也要兼顾经济因素。

Clinical Analysis and Clinical Economic Evaluation of Two Treatments for Children with Idiopathic Thrombocytopenic Purpura

Objective To investigate the clinical efficacy and economic evaluation of 2 treatments for 70 children with idiopathic thrombocytopenic purpura(ITP).Methods The glucocorticoid(GC) alone treatment and GC combined with intravenous immunoglobulin(IVIG) treatment were retrospectively analyzed,and the economic evaluation was made by cost-effectiveness analysis methods.The data were analyzed by SPSS 14.0 software.Results There was no statistical difference in the side effects and follow-up visits between 2 groups.The cases with platelet counts of(10-25)×109 L-1 or less than 10×109 L-1 and severe bleeds in IVIG plus GC treatment group were more than that in GC treatment group.The days which the platelets reached the normal level from the 1st day to the 7th day,the effective rate and significant effective rate in IVIG plus GC treatment group were higher or better than that in GC treatment group.The result of economic evaluation in GC treatment group was better than that in IVIG plus GC treatment group.Conclusions The cases with platelet counts of(10-25)×109 L-1 or less than 10×109 L-1,severe bleeds should be treated with IVIG plus GC treatment,while the others with GC treatment.Many factors should be considered to choose the ways of clinical treatment,including the clinical curative effect and economics.