静脉注射免疫球蛋白与泼尼松龙治疗儿童特发性血小板减少性紫癜初始应用的对比研究

A comparative study of initial use of intravenous immunoglobulin and prednisolone treatments in childhood idiopathic thrombocytopenic purpur.

作者信息

Ou Chun-Yen, Hsieh Kai-Sheng, Chiou Yee-Hsuan, Chang Yu-Hsiang, Ger Luo-Ping

机构信息

Department of Pediatrics, Pao-Chien Hospital, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

出版信息

Acta Paediatr Taiwan. 2006 Sep-Oct;47(5):226-31.

PMID:17352309

Abstract

BACKGROUND

Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by immune-mediated platelet destruction. The aims of this study were to compare initial platelet count elevation and to determine the chance of developing persistent profound thrombocytopenia by intravenous immunoglobulin (IVIG) or prednisolone in the treatment of children with ITP.

METHODS

Eighty-seven children, aged from 3 months to 14 years old, diagnosed with ITP and initial platelet count less than 20 x 10(3)/mm3 were divided into two groups. Fifty-four patients received IVIG (1 g/kg/dose) for two days. Then, they received prednisolone treatment at a dose of 1 mg/kg/d starting on day 8 to maintain platelet count, followed by a tapering dose until day 60. Thirty-three patients received prednisolone (2 mg/kg/day) for 14-21 days, followed by a tapering dose until day 60. Platelet counts were evaluated on presentation days 2, 3, 5, 7, 30, 60, 90, 120, 150 and 180.

RESULTS

Forty-four of 54 patients (81.5%) treated with IVIG demonstrated a rapid increase in platelet count above 20 x 10(3)/mm3 on the second day, compared to 13 of 33 patients (39.4%) in the group treated with prednisolone initially (p<0.01). There were no significant differences in mean platelet counts between both groups on days 3, 5, 7 or 30, 60, 90, 120, and 180 (all p>0.05). No serious bleeding, such as ICH, was noted in either treatment group. Persistent platelet counts lower than 20 x 10(3)/mm3 after 6 months of follow-up developed in 18 patients (33.3%) in the IVIG group and in 10 patients (30.3%) in the prednisolone group (p=0.480).

CONCLUSIONS

In our study, patients treated with IVIG demonstrated a higher percentage of patients with platelet count increasing above 20 x 10(3)/mm3 on the second day compared with patients treated with prednisolone initially (p<0.01). However, there was no difference in developing persistent platelet counts lower than 20 x 10(3)/mm3 at 6 months of follow-up between the IVIG and prednisolone groups (p=0.480).

摘要

背景

特发性血小板减少性紫癜（ITP）是一种以免疫介导的血小板破坏为特征的获得性疾病。本研究的目的是比较静脉注射免疫球蛋白（IVIG）或泼尼松龙治疗儿童ITP时初始血小板计数的升高情况，并确定发生持续性严重血小板减少的几率。

方法

87名年龄在3个月至14岁之间、诊断为ITP且初始血小板计数低于20×10³/mm³的儿童被分为两组。54名患者接受IVIG（1g/kg/剂量）治疗两天。然后，从第8天开始接受1mg/kg/d的泼尼松龙治疗以维持血小板计数，随后逐渐减量直至第60天。33名患者接受泼尼松龙（2mg/kg/天）治疗14 - 21天，随后逐渐减量直至第60天。在就诊第2、3、5、7、30、60、90、120、150和180天评估血小板计数。

结果

接受IVIG治疗的54名患者中有44名（81.5%）在第二天血小板计数迅速升至20×10³/mm³以上，而初始接受泼尼松龙治疗的33名患者中有13名（39.4%）（p<0.01）。在第3、5、7天或第30、60、90、120和180天，两组间平均血小板计数无显著差异（所有p>0.05）。两个治疗组均未观察到严重出血，如颅内出血。随访6个月后，IVIG组有18名患者（33.3%）、泼尼松龙组有10名患者（30.3%）血小板计数持续低于20×10³/mm³（p = 0.480）。