Dubbeld P, van der Heul C, Hillen H F
Department of Internal Medicine, Sint Elisabeth Hospital, Tilburg, The Netherlands.
Neth J Med. 1991 Aug;39(1-2):6-10.
This study investigated whether high-dose dexamethasone pulse therapy could bring about a remission in adult chronic idiopathic thrombocytopenic purpura (ITP) patients who had not achieved a remission on the usual prednisone therapy. Newly diagnosed patients with ITP received the usual prednisone therapy, 1 mg/kg/day, for 3 weeks, after which period the dosage was tapered off. If after 6 weeks of treatment the platelets were less than 50 x 10(9)/l the prednisone therapy was considered a failure and 200 mg dexamethasone i.v. was given on 3 consecutive days. Six of the twenty-five patients with newly diagnosed ITP treated according to this protocol achieved a sufficient response with prednisone therapy. Nineteen patients were resistant to or relapsed during prednisone therapy and were treated with high-dose dexamethasone. Four of these nineteen patients showed a sufficient response. Three are still in remission. As no serious adverse effects were observed, high-dose dexamethasone therapy can be considered before splenectomy in prednisone- resistant ITP patients.
本研究调查了高剂量地塞米松冲击疗法能否使那些常规泼尼松治疗未达缓解的成人慢性特发性血小板减少性紫癜（ITP）患者实现缓解。新诊断的ITP患者接受常规泼尼松治疗，剂量为1mg/kg/天，持续3周，之后逐渐减量。若治疗6周后血小板计数低于50×10⁹/L，则认为泼尼松治疗失败，给予200mg地塞米松静脉注射，连续3天。按照该方案治疗的25例新诊断ITP患者中，6例经泼尼松治疗获得了充分缓解。19例患者在泼尼松治疗期间耐药或复发，接受了高剂量地塞米松治疗。这19例患者中有4例显示出充分缓解。3例仍处于缓解状态。由于未观察到严重不良反应，对于泼尼松耐药的ITP患者，在脾切除术前可考虑采用高剂量地塞米松治疗。
