大剂量地塞米松用于免疫性血小板减少性紫癜的初始治疗。

Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone.

作者信息

Cheng Yunfeng, Wong Raymond S M, Soo Yannie O Y, Chui Chung Hin, Lau Fung Yi, Chan Natalie P H, Wong Wai Shan, Cheng Gregory

机构信息

Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin NT, Hong Kong.

出版信息

N Engl J Med. 2003 Aug 28;349(9):831-6. doi: 10.1056/NEJMoa030254.

DOI:10.1056/NEJMoa030254

PMID:12944568

Abstract

BACKGROUND

The role of high-dose dexamethasone in the treatment of immune thrombocytopenic purpura in adults is controversial. We assessed the effectiveness of high-dose dexamethasone as initial treatment in a series of consecutive adults with immune thrombocytopenic purpura.

METHODS

Consecutive patients with newly diagnosed immune thrombocytopenic purpura and a platelet count of less than 20,000 per cubic millimeter or a platelet count of less than 50,000 per cubic millimeter and clinically significant bleeding were enrolled between January 1997 and December 2000. Oral dexamethasone at a dose of 40 mg per day for four consecutive days was the initial treatment. A response was defined as an increase in the platelet count of at least 30,000 per cubic millimeter and a platelet count of more than 50,000 per cubic millimeter by day 10 after the initiation of treatment. A sustained response was defined as a platelet count of more than 50,000 per cubic millimeter six months after the initial treatment.

RESULTS

Of 157 consecutive patients, 125 were eligible. The mean (+/-SD) platelet count before treatment was 12,200+/-11,300 per cubic millimeter. A good initial response to high-dose dexamethasone occurred in 106 of the 125 patients (85 percent): the platelet count increased by at least 20,000 per cubic millimeter by the third day of treatment, and the mean platelet count was 101,400+/-53,200 per cubic millimeter (range, 50,000 to 260,000 per cubic millimeter) one week after the initiation of treatment. Among the 106 patients with a response, 53 (50 percent) had a sustained response; the other 53 (50 percent) had a relapse within six months, most of them (94 percent) within the first three months. A platelet count of less than 90,000 per cubic millimeter on day 10 was associated with a high risk of relapse. The treatment was well tolerated.

CONCLUSIONS

A four-day course of high-dose dexamethasone is effective initial therapy for adults with immune thrombocytopenic purpura.

摘要

背景

高剂量地塞米松在成人免疫性血小板减少性紫癜治疗中的作用存在争议。我们评估了高剂量地塞米松作为一系列连续性成人免疫性血小板减少性紫癜初始治疗方法的有效性。

方法

选取1997年1月至2000年12月期间连续收治的新诊断免疫性血小板减少性紫癜患者，血小板计数低于每立方毫米20,000或血小板计数低于每立方毫米50,000且有临床显著出血症状的患者。初始治疗为连续4天口服地塞米松，剂量为每日40毫克。治疗反应定义为治疗开始后第10天时血小板计数至少增加每立方毫米30,000且血小板计数超过每立方毫米50,000。持续反应定义为初始治疗6个月后血小板计数超过每立方毫米50,000。

结果

157例连续患者中，125例符合条件。治疗前平均（±标准差）血小板计数为每立方毫米12,200±11,300。125例患者中有106例（85%）对高剂量地塞米松有良好的初始反应：治疗第3天时血小板计数至少增加每立方毫米20,000，治疗开始1周后平均血小板计数为每立方毫米101,400±53,200（范围为每立方毫米50,000至260,000）。在有反应的106例患者中，53例（50%）有持续反应；另外53例（50%）在6个月内复发，其中大多数（94%）在头3个月内复发。第10天时血小板计数低于每立方毫米90,000与高复发风险相关。该治疗耐受性良好。