Bussel J B
Department of Pediatrics, Weill Medical College of Cornell University, New York, NY 10021, USA.
Semin Oncol. 2000 Dec;27(6 Suppl 12):91-8.
Idiopathic thrombocytopenic purpura is a disorder in which autoantibodies are made to platelets, resulting in accelerated platelet destruction. The diagnosis may be made in outpatients who are previously well or in patients with multiple medical conditions and medications. There are no unequivocal ways to distinguish immune thrombocytopenias from other thrombocytopenias, even with state-of-the-art tests including anti-platelet antibodies, thrombopoietin, glycocalicin, and platelet reticulocyte counts. Clinical evaluation includes ruling out a systemic process such as a viral infection or leukemia. Treatment of idiopathic thrombocytopenic purpura should be individualized. Substantial platelet increases are seen in more than 50% of patients who receive intravenous IgG, intravenous anti-D, steroids, or splenectomy. Two additional agents showing promising clinical trial experience are anti-CD40 ligand and rituximab (Rituxan; Genentech, Inc, South San Francisco, CA and IDEC Pharmaceutical Corporation, San Diego, CA).
特发性血小板减少性紫癜是一种自身抗体作用于血小板，导致血小板加速破坏的疾病。该诊断可在既往健康的门诊患者或患有多种疾病并正在使用多种药物的患者中做出。即使采用包括抗血小板抗体、血小板生成素、糖萼蛋白和血小板网织红细胞计数在内的先进检测方法，也没有明确的方法将免疫性血小板减少症与其他血小板减少症区分开来。临床评估包括排除病毒感染或白血病等全身性疾病。特发性血小板减少性紫癜的治疗应个体化。超过50%接受静脉注射免疫球蛋白、静脉注射抗-D、类固醇或脾切除术的患者血小板显著增加。另外两种在临床试验中显示出良好效果的药物是抗CD40配体和利妥昔单抗（美罗华；基因泰克公司，加利福尼亚州南旧金山和IDEC制药公司，加利福尼亚州圣地亚哥）。
