免疫性血小板减少症老年患者个体化治疗的研究进展

免疫性血小板减少症(ITP)是一种由体液免疫及细胞免疫异常共同介导的自身免疫性疾病,血小板破坏增多及生成减少共同参与其发病.既往普遍认为儿童及育龄期妇女为ITP的高发人群,但近年来相关文献报道,随着年龄的增长,ITP的发病率不断增高,年龄≥60岁的老年人已经成为新的ITP高发人群.由于ITP老年患者合并症多,对治疗反应及耐受性较年轻患者差,更易发生严重的出血症状,病死率增高.目前,针对ITP老年患者的经典治疗方法包括:糖皮质激素、静注人免疫球蛋白(IVIG)、脾切除术、免疫抑制剂等,但是约1/3的ITP老年患者接受治疗后,疾病仍迁延不愈.随着相关研究的深入,利妥昔单抗、血小板生成素受体激动剂(TPORA)罗米司亭与艾曲波帕、新型免疫抑制剂霉酚酸酯(MMF)等新药在治疗ITP老年患者中均显示出较好的疗效,然而根据ITP老年患者的具体情况对其实施个体化治疗变得越来越重要.笔者拟对ITP的个体化治疗方法及其最新研究进展,结合ITP老年患者这一特殊群体的具体情况进行综述.

Research progress of individual therapies in elderly patients with immune thrombocytopenia

Immune thrombocytopenia (ITP) is an autoimmune disorder mediated by both humoral and cellular immunologic abnormalities.Both accelerated destruction of platelets and reduced platelet production participate in the pathogenesis of ITP.It has been previously considered that ITP affects predominantly young or middle-aged women.However,according to recent literatures,the incidence rate increases with age and old patients over the age of 60 become a new population of this disease.Elderly patients with ITP have more complications and worse reaction or tolerance to treatments,and have a higher risk of severe bleeding and increasing mortality than younger patients.The classical therapies of elderly patients with ITP include corticosteroids,intravenous immunoglobulin (IVIG),splenectomy and immune suppression,but still about one-third of the patients can't receive sustained remission.Recently,with the continuously deepening research,new drugs such as rituximab,thrombopoietin receptor agonist (TPORA) like romiplostim and eltrombopag,mycophenolic mofetil (MMF),etc.,have been used in the treatment of elderly patients with ITP,and the results are convincing.Nevertheless,individual treatment according to different pathogenesis becomes more and more important,especially in elderly patients with ITP.In this review,we will discuss the therapies and the latest progress of elderly patients with ITP.