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目的了解单次小剂量(0.4g/kg)静脉输注免疫球蛋白(IVIG)提升初发免疫性血小板减少性紫癜(ITP)患儿血小板至安全范围(≥30×109/L)的作用。方法研究对象为北京大学第一医院儿科2008-04-01—2011-04-01收治初发ITP患儿62例,其中2008-04-01—2009-10-01收治的30例为激素组,初始接受常规剂量醋酸泼尼松治疗;2009-10-02—2011-04-01就诊的32例为IVIG组,初始接受0.4g/(kg·d)IVIG治疗1～5d,每天复查血常规,血小板升至安全范围则规范停用。比较两组治疗第1、3、5天时血小板升至安全范围比例及长期随访结果。结果治疗前,激素组和IVIG组血小板中位值分别是10×109/L和6×109/L。治疗1d后两组血小板升至安全范围的比例分别是3.33%和43.75%,差异有统计学意义(P<0.01)。随访7～42个月后激素组和IVIG组分别有3.45%和3.23%血小板未升至正常(≥100×109/L)。所有患儿均无颅内出血发生及死亡。结论单次小剂量IVIG可使近半数初治ITP患儿血小板升至≥30×109/L相对安全范围,明显高于常规剂量醋酸泼尼松疗效。

Study of efficacy of single low-dose intravenous immunoglobulin in elevating platelet counts

??Abstract??Objective To evaluate the efficacy of single low-dose intravenous immunoglobulin ??IVIG?? in treatment for children with newly diagnosed immune thrombocytopenia ??ITP??. Methods Of 62 childrenwithnewly diagnosed ITP??30 patients admitted to hospital before October 2009 were initially given standard-dose prednisone??steroids group????and 32 from October 2009 to April 2011 initially received IVIG ??400 mg/??kg·d???? treatment for 1??5 days??IVIG group??.Platelet counts were evaluated after presentation days 1??3??5 and in the follow-up. Results The mean platelet counts in steroids group and IVIG group were 10 × 109/L and 6 × 109/L before treatment.By day 1 after treatment??43.57%children in IVIG group had rapid platelet count recovery??reaching safe level ??30 × 109/L????which was higher than 3.33% in steroids group??P??0.01??.By day 3 and 5??the percentage of cases with platelet count increasing above 30 × 109/L in steroids group and IVIG group were 46.67% vs 65.63% and 80.00% vs 81.25%??respectively.After 7??42 months of follow-up??there were 3.45% in steroids group and 3.23%in IVIG group whose platelet count didn't turn normal.No intracranial hemorrhage or death was recorded. Conclusion ChildhoodITP patients treated withone low-dose IVIG ??400 mg/kg?? demonstrate a higher percentage with platelet count increasing above 30 × 109/L on the second day??compared with those treated with prednisone initially??the effect is much better.