特发性血小板减少性紫癜无效输注原因分析

目的:探讨特发性血小板减少性紫癜(ITP)患者血小板无效输注的原因.方法:90例确诊的ITP患者中对输注血小板的48例计算血小板计数增高指数(CCI),评价输注的效果并分析与感染、脾脏肿大、血小板抗体、骨髓巨核细胞数和免疫指标等因素的关系.结果:18例应用血小板和激素治疗的患者,44.4%有效输注,30例应用血小板、激素和丙种球蛋白患者,53.3%有效输注.24例无效输注患者中在感染组与非感染组、脾脏肿大组与正常组、血小板相关抗体升高组与正常组,有效输注率有显著性差异.骨髓巨核细胞数升高组与正常组、调节性T细胞低表达组与正常组,有效输注率差异无统计学意义.结论:ITP患者输注血小板50%存在无效输注,其原因可能与感染、脾脏肿大、血小板相关抗体有关.因此控制感染和抑制免疫应作为首选治疗,而血小板的输注应严格把握指征.

Analysis of refractoriness to platelet transfusion in patients with idiopathic thrombocytopenic purpura

Objective:To study the reasons of refractoriness to platelet transfusion in patients with idiopathic thrombocytopenic purpura(ITP).Method:Among 90 ITP patients,48 patients who received platelet transfusion were assessed the effect of transfusion by counting the corrected count increment(CCI)and then the relationship between the effective rate and the conditions or indexes of patients such as infection,splenomegaly,platelet associated antibody,megalokaryocytes amounts in bone marrow and regulatory T cells were also assessed.Result:44.4% patients with ITP had efficient transfusions among 18 patients who received platelet transfusion and corticosteroids,while 53.3% effective rate was reached among 30 patients who received platelet transfusion,corticosteroids and immunoglobulin-G.Among 24 patients with ITP who were refractory to platelet transfusion,there was significant difference not only between infection group and non-infection group,but also between splenomegaly group and non-splenomegaly group,or between high-platelet associated antibody group and normal group.But there was no significant difference between low-regulatory T cells group and normal group,or between high-megalokaryocytes amounts group and normal group.Conclusion:50% of ITP patients get refractoriness to platelet transfusion.The reasons perhaps include infection,splenomegaly and high level of platelet associated antibody.So the optimized therapy is to control the infections and suppress immunity at first,while the platelet transfusion should be used only when necessary.