Pavkovic M, Trpkovska-Terzieva S, Sotirova T, Latifi A, Cevreska L, Stojanovic A
University Clinic for Haematology, Medical Faculty, Skopje, R. Macedonia.
Prilozi. 2012;33(1):121-33.
Immune thrombocytopenic purpura (ITP) is a benign disease with low morbidity and mortality and frequent remissions that occur spontaneously or in response to first-line treatment with steroids or splenectomy.
The purpose of this study is to describe the clinical outcomes of 170 patients with ITP diagnosed and/or treated in our hospital between 2000 and 2010.
The median age at diagnosis was 47 years. Forty three (25%) were asymptomatic, 65% had minor skin or mucosal bleeding and 10% had significant bleeding from the gastrointestinal or genitourinary system. The median platelet count at diagnosis was 13x10(9)/L (range: 0-98x10(9)/L). Median follow-up of all patients was 13 months. Ninety-five patients had a follow-up longer than 12 months, with median 44 months (range 14-384). Corticosteroids were the initial treatment for 161/170 (95%) patients, 38 (22%) were splenectomized, 25 (14.7%) were treated with intravenous gamma globulins, while 9 did not received any specific treatment. A complete response to initial treatment (prednisone±splenectomy) was achieved in 55/161 (34.2%), a partial response in 90 (55.9%) and no response in 16 (9.9%) patients. In the group of patients with follow-up longer than 1 year; 28 (29%) patients had refractory or unresponsive ITP with a median follow-up of 66 months. All patients with refractory ITP were treated with steroids, 11 were splenctomized, significantly more patients with refractory ITP 12 (43%) were treated with IVIG compared with other ITP patients (16%), p=0.005. The median age of 38 splenectomized patients was 28 years and it is significantly different from the other patients (p<0.001). There were no significant differences in other characteristics between splenctomized or refractory ITP and other patients at diagnosis.
Our results were similar to results already reported in other similar studies.
免疫性血小板减少性紫癜（ITP）是一种良性疾病，发病率和死亡率较低，常可自发缓解或经一线治疗（使用类固醇或脾切除术）后缓解。
本研究旨在描述2000年至2010年间在我院诊断和/或治疗的170例ITP患者的临床结局。
诊断时的中位年龄为47岁。43例（25%）无症状，65%有轻微皮肤或黏膜出血，10%有胃肠道或泌尿系统严重出血。诊断时的中位血小板计数为13×10⁹/L（范围：0 - 98×10⁹/L）。所有患者的中位随访时间为13个月。95例患者随访时间超过12个月，中位随访时间为44个月（范围14 - 384个月）。161/170例（95%）患者初始治疗采用皮质类固醇，38例（22%）接受脾切除术，25例（14.7%）接受静脉注射丙种球蛋白治疗，9例未接受任何特异性治疗。161例接受初始治疗（泼尼松±脾切除术）的患者中，55例（34.2%）完全缓解，90例（55.9%）部分缓解，16例（9.9%）无缓解。在随访时间超过1年的患者组中，28例（29%）患者患有难治性或无反应性ITP，中位随访时间为66个月。所有难治性ITP患者均接受类固醇治疗，11例接受脾切除术，与其他ITP患者相比，显著更多的难治性ITP患者12例（43%）接受静脉注射丙种球蛋白治疗（16%），p = 0.005。38例接受脾切除术患者的中位年龄为28岁，与其他患者有显著差异（p < 0.001）。在诊断时，接受脾切除术或难治性ITP患者与其他患者在其他特征方面无显著差异。
我们的结果与其他类似研究中已报道的结果相似。
