联合使用免疫抑制剂治疗难治性原发免疫性血小板减少症的疗效及其对血小板相关抗体水平影响的研究

目的观察联合使用免疫抑制剂治疗难治性原发免疫性血小板减少症（ITP）的疗效，研究联合使用免疫抑制剂对难治性ITP患者血小板相关抗体（PAIG）水平的影响。方法2009年2月-2013年2月，将22例难治性ITP患者按入院号顺序随机分为联合治疗组和单药治疗组。联合治疗组先予甲泼尼龙及静脉免疫球蛋白滴注，血小板值迅速上升后联合使用2～3种不同组合的免疫抑制剂；单药组先予甲泼尼龙及静脉免疫球蛋白滴注，血小板上升后接受1种免疫抑制剂治疗。维持治疗3～6个月，结束治疗后随访6～24个月。运用流式细胞术检测治疗前后患者血清PAIG水平。结果联合治疗组显效6例，良效2例，进步1例，无效2例，对照组显效0例，良效2例，进步1例，无效7例，两组治疗反应差异有统计学意义（Z=-2．796，P=0．005）。两组对象治疗后PAIG水平均明显降低，联合治疗组治疗后PAIG水平明显低于单药治疗组，差异有统计学意义（P〈0．05）。结论联合使用免疫抑制剂治疗治疗难治性ITP疗效较好，且能明显降低患者的PAIG水平。

Clinical Efficacy of Combined Immunosuppressant Therapy on Chronic Refractory Immune Thrombocytopenia Purpura and Its Effects on the Level of Platelete-associated antibody

Objective To observe the clinical efficacy of combined immunosuppressant therapy for patients with chronic refractory immune thrombocytopenia purpura （ITP） and its effects on platelete-associated antibody （PAIG） level. Methods Between February 2009 and February 2013, 22 patients with refractory ITP were randomly divided into ＇e drugs combination treatment group and single drug treatment group. The combination treatment group was treated with methylprednisolone and intravenous immunoglobulin （IVIG）, and after the fast increasing of platelet count, combined chemotherapy consisting of two or three kinds of immunosuppressive agents was adopted. The single treatment group was also treated with methylprednisolone and WIG, but took only one immunosuppressive agent after the fast increasing of platelet count. The treatment maintained for 3 to 6 months. The duration of follow-up was 6-36 months. We used flow cytometry to detect PAIG of the patients. Results The total effective rate of combination treatment group was 81.8%, significantly higher than that of the single treatment group （36.4%） （P 〈 0.05）. PAIG decreased obviously in both the two groups, and the PAIG level of the combination treatment group was much lower than that of the single treatment group （P 〈 0.05）. Conclusion Immunosuppresant combination chemotherapy is a powerful approach for patients with refractory ITP, and it can decrease patient＇s PAIG level simultaneously.