合并巨细胞病毒感染的特发性血小板减少性紫癜临床特征与治疗分析

目的探讨合并巨细胞病毒感染的特发性血小板减少性紫癜（ITP）临床特征及治疗效果，提出影响其疗效的相关因素。方法回顾性对比分析2006年入我科治疗的合并巨细胞病毒感染的ITP患儿的临床资料。结果42例痊愈，其中35例患儿未加用更昔洛韦及干扰素抗病毒治疗，仅在冲击治疗后（5d内）血小板升至正常水平，且能稳定3个月；有7例因血小板计数上升较慢或不稳定，加用更昔洛韦及干扰素抗病毒治疗后，血小板计数升至正常且稳定3个月；11例好转患儿冲击治疗后血小板计数仍未达正常水平，或血小板计数正常后在1月内又出现反复，在加用更昔洛韦及干扰素抗病毒治疗后血小板计数才达正常水平，但未稳定3个月，一旦遇到感染等诱因，血小板计数又可降至正常以下；5例进步患儿经上述所有治疗血小板计数虽仍不正常。但治疗3个月后，血小板计数有所上升，出血症状消失。结论合并巨细胞病毒感染的ITP患儿，绝大部分为隐性感染。以3岁以下居多，且有年龄越小，治疗效果越好的趋势。对于冲击治疗效果不佳的病例，加用更昔洛韦及干扰素抗病毒治疗，有效率占78.3％。

Clinical features and treatment of TTP patients co-infected with cytomegalovirus

Objective To study the clinical features and treatment of eytomegalovirus co-infection in patients with idiopathic thrombocy-topenic purpura （ITP）. Methods Clinical data of children patients who were co-infected with cytomegalovirus and treated in our pediatrics, 2006, were reviewed and comparatively analyzed. Results① Of the 42 cured cases, 35 children recovered without the usage of gancielovir and interferon. The platelets rose to normal level and maintained for 3 months after the mere shock therapy （ within 5 days）. Seven children were cured by additional usage of gancielovir and interferon owing to the slow or unsteady rise of platelets. The platelets rose to normal level and maintained for 3 months.②Eleven children＇s condition improved after shock therapy but the number of platelets was below normal, or after rising to the normal level, it fluctuated within one month. Only after the additional usage of ganciclovir and interferon, the number of platelets could reach the normal level but was not steady in the following 3 month. Once the children infected, the number of platelets fell below normal level. ③5 children＇s condition was slightly improved but the platelet counts were still abnormal. After 3 months＇treatment, platelet counts had risen a bit and hemorrhage disappeared. Conclusion Most of the co-infection by cytomegalovirus in ITP children was probably occult infection and the majority of the children were under 3 years old. The younger a child was the better effects the therapy tends to have. For those who had poor treatment results, the efficiency of additional usage of ganciclovir and interferon is 78.3%.