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不同剂量静脉注射免疫球蛋白(IVIg)治疗免疫性血小板减少症的三年长期随访:一项纳入167例患者的前瞻性研究结果

Different dosages of intravenous immunoglobulin (IVIg) in treating immune thrombocytopenia with long-term follow-up of three years: Results of a prospective study including 167 cases.

作者信息

Zhou Zeping, Qiao Zhuoqing, Li Huiyuan, Luo Na, Zhang Xian, Xue Feng, Yang Renchi

机构信息

a Department of Hematology , Second Affiliated Hospital of Kunming Medical University , Kunming , China .

b Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Tianjin , China .

出版信息

Autoimmunity. 2016;49(1):50-7. doi: 10.3109/08916934.2015.1104671. Epub 2015 Nov 2.

DOI:10.3109/08916934.2015.1104671
PMID:26525513
Abstract

This study compared the effects of different dosages of intravenous immunoglobulin (IVIg) against immune thrombocytopenia (ITP). A total of 167 patients, 91 adults and 76 children, with ITP, followed-up for three years in the case-control study, were divided into three subgroups according to the dosages of IVIg administered: group A (0.2 g/kg/day), group B (0.3 g/kg/day) and group C (0.4 g/kg/day). The therapeutic response in 91 adult patients did not differ significantly among the three groups of IVIg dosages (p = 0.459). The response rate of IVIg treatment in the three adult groups was 97.1% for group A, 97.2% for group B and 100% for group C. The mean time for raising platelets to 30 × 10(9)/L in group A was 2.5 days, group B 3.2 days and group C 2.9 days (p = 0.324). The median IVIg consumption in group A was 0.83 g/kg, group B 1.22 g/kg and group C 1.64 g/kg (p < 0.01). Similar results were shown in the children groups. The follow-up results showed no significant difference of clinical outcome between groups A, B and C. In conclusion, low-dose IVIg treatment is shown to be as effective as high-dose regimen without increasing the risk of developing the patients into chronic ITP conditions, suggesting that ITP patients could be treated more cost-effectively by lower conventional dosage of IVIg regimen.

摘要

本研究比较了不同剂量静脉注射免疫球蛋白(IVIg)治疗免疫性血小板减少症(ITP)的效果。在这项病例对照研究中,共有167例ITP患者,其中91例成人和76例儿童,随访三年,根据IVIg给药剂量分为三个亚组:A组(0.2g/kg/天)、B组(0.3g/kg/天)和C组(0.4g/kg/天)。91例成年患者在三种IVIg剂量组中的治疗反应差异无统计学意义(p = 0.459)。三组成年患者IVIg治疗的有效率分别为:A组97.1%,B组97.2%,C组100%。A组血小板升至30×10⁹/L的平均时间为2.5天,B组为3.2天,C组为2.9天(p = 0.324)。A组IVIg的中位消耗量为0.83g/kg,B组为1.22g/kg,C组为1.64g/kg(p < 0.01)。儿童组也显示出类似结果。随访结果显示,A、B、C组之间的临床结局无显著差异。总之,低剂量IVIg治疗与高剂量方案同样有效,且不会增加患者发展为慢性ITP的风险,这表明ITP患者采用较低的常规IVIg剂量方案治疗可能更具成本效益。

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Guideline on immune thrombocytopenia in adults: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Project guidelines: Associação Médica Brasileira - 2018.成人免疫性血小板减少症指南:巴西血液学、血液治疗与细胞治疗协会。项目指南:巴西医学协会 - 2018年。
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