激素联合静注免疫球蛋白治疗狼疮合并血小板减少

目的探讨糖皮质激素联合静注免疫球蛋白（IVIG）治疗系统性红斑狼疮（SLE）合并血小板减少的疗效及安全性。方法30例合并中重度血小板减少的SLE患者，随机分为实验组和对照组，每组15例。两组患者均接受糖皮质激素治疗；实验组联合应用静注免疫球蛋白（400mg/Kg/day，连用3天）。观察两组患者血小板计数变化、血小板恢复正常（100×10^9／L）的时间（天）、2周完全缓解率、平均住院日等。结果（1）治疗第4、7、10、14天实验组平均血小板计数高于对照组，差异具有统计学意义；（2）实验组血小板计数恢复正常的时间较对照组缩短（9．7±4．2天VS13．5±5．3天，P〈0．05）；实验组2周完全缓解率显著高于对照组（93．3％vs46．7％，P〈0．05）；（3）对照组患者的平均住院日为16．1±4．4天，实验组平均住院日为12．7±3．7天，两组比较差异具有统计学意义（P〈0．05）。（4）治疗过程中无严重不良反应发生。结论糖皮质激素联合静注免疫球蛋白治疗狼疮合并中重度血小板减少具有较好的疗效及安全性。

Corticosteroids Combined with Intravenous Immunoglobulin in the Treatment of Systemic Lupus Erythematosus Patients with. Thrombocytopenia

Abstract Objective To evaluate the efficacy and safety of corticosteroids combined with intravenous immunogtobulin （IVIG） in systemic lupus erythematous （SLE） patients with thrombocytopenia. Method A total of 30 SLE patients with thrombocytopenia were enrolled in this study. The patients were randomly assigned to receive corticosteroids combined with IVIG （400mg/Kg/day for 3 consecutive days） or corticosteroids alone. Outcome measures included improvement in platelet counts, platelet recovery time, 2-week complete response （platelet count ≥ 100 × 10^9 /l） and duration of hospitalization. Result （1）In IVIG group, there were more rapid increases in platelet counts at 4, 7, 10, 14 days after treatment than control group. （2）Mean （ ± standard deviation, SD） platelet recovery time for IVIG group was shorter than that for control group （9.7 ± 4.2days versus 13.5 ± 5.3 days, P〈0.05）. 2 weeks after treatment, 93.3 % of patients in IVIG group achieved complete responses, while 46.7% patients in eontrol group achieved complete responses （P〈0.05）. （3）Patients in IVIG group had a shorter mean （ ± SD） hospitalization time compared with those in eontrol group （12.7 ±3.7 days versus 16.1 ±4.4 days, P〈0.05）. （4）No severe adverse effects were reported in either group. Conclusion Corticosteroids combined with IVIG was effective and safe in treatment for SLE patients with thrombocytopenia.