单疗程大剂量地塞米松治疗优于常规泼尼松龙治疗原发性新诊断免疫性血小板减少症。
Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia.
机构信息
Genetics research center, Division of Oncology and Hematology, Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
出版信息
Daru. 2012 Aug 28;20(1):7. doi: 10.1186/2008-2231-20-7.
INTRODUCTION
Immune thrombocytopenia (ITP) is an immune disorder commonly presents as isolated thrombocytopenia. Generally corticosteroids are the main treatment of ITP. This study was designed to evaluate effectiveness of high dose dexamethasone comparing conventional corticosteroid therapy in the treatment of ITP.
MATERIALS AND METHODS
In a randomized prospective study, sixty adult patients with newly diagnosed primary symptomatic ITP (Platelet count < 20,000) were evaluated. Patients divided into two groups. In group A, thirty patients (mean age of 24.9 years) received Dexamethasone 40 mg/IV/daily for four days (10 mg/q6h); and then Prednisolone 1 mg/kg/day/PO with rapid tapering of prednisolone (10 mg/week). From the other hand, in group B, thirty patients (mean age of 27.2 years) were treated with Prednisolone 1 mg/kg/day/PO for four weeks, then the drug tapered weekly.
RESULTS
All the patients in group A showed favorable response within the first seven days, 27 cases presented complete response (CR) and three cases revealed response (R). In group B, 11 cases had CR, 13 cases showed R and six cases had No response (NR). After three months, rates of CR were 80% and 23.3% in group A and B; respectively. Responses were 16.7% and 33.3%, NRs were 6.6% and 43.3% in group A and B; respectively (P < 0.0001). After 6 months, CR was 73.3% vs.16.7%, and R was 16.7% vs.36.7% and NR was 10% vs. 46.7% in group A and B; respectively (P < 0.0001). After 12 months, there was no change in response rate in group A, but in group B 53% were non responsive, 40% showed R (chronic ITP) and complete response was observed only in 6.7% (P < 0.0001). Three cases in group A and 12 cases in group B had needed splenectomy (P < 0.00002).
CONCLUSION
We showed that high dose dexamethasone is more effective than conventional steroid therapy in newly diagnosed ITP as initial treatment with less relapses and toxicities.
简介
免疫性血小板减少症（ITP）是一种常见的免疫性疾病，表现为孤立性血小板减少症。一般来说，皮质类固醇是 ITP 的主要治疗方法。本研究旨在评估大剂量地塞米松与常规皮质类固醇治疗 ITP 的疗效。
材料与方法
在一项随机前瞻性研究中，评估了 60 例新诊断的原发性有症状 ITP（血小板计数<20,000）的成年患者。患者分为两组。在 A 组中，30 例患者（平均年龄 24.9 岁）接受地塞米松 40mg/IV/天，连用 4 天（10mg/q6h）；然后给予泼尼松龙 1mg/kg/天/PO，并快速减停泼尼松龙（每周 10mg）。另一方面，在 B 组中，30 例患者（平均年龄 27.2 岁）接受泼尼松龙 1mg/kg/天/PO 治疗 4 周，然后每周减药。
结果
A 组所有患者在第 7 天内均出现良好反应，27 例患者完全缓解（CR），3 例患者反应良好（R）。B 组中，11 例患者 CR，13 例患者 R，6 例患者无反应（NR）。3 个月后，A 组和 B 组的 CR 率分别为 80%和 23.3%；分别。反应率分别为 16.7%和 33.3%，NR 率分别为 6.6%和 43.3%；分别（P<0.0001）。6 个月后，CR 分别为 73.3%和 16.7%，R 分别为 16.7%和 36.7%，NR 分别为 10%和 46.7%；分别（P<0.0001）。12 个月后，A 组的反应率没有变化，但 B 组中有 53%的患者无反应，40%的患者反应良好（慢性 ITP），只有 6.7%的患者完全缓解（P<0.0001）。A 组有 3 例患者和 B 组有 12 例患者需要脾切除术（P<0.00002）。
结论
我们表明，与常规类固醇治疗相比，大剂量地塞米松作为初治新诊断的 ITP 更为有效，复发和毒性更少。
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