泼尼松联合静脉注射免疫球蛋白与泼尼松或静脉注射免疫球蛋白治疗妊娠期免疫性血小板减少症的全国性回顾性队列研究。
Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study.
作者信息
Zhu Xiao-Lu, Feng Ru, Huang Qiu-Sha, Liang Mei-Ying, Jiang Ming, Liu Hui, Liu Yi, Yao Hong-Xia, Zhang Lei, Qian Shen-Xian, Yang Tong-Hua, Zhang Jing-Yu, Shen Xu-Liang, Yang Lin-Hua, Hu Jian-Da, Huang Ren-Wei, Jiang Zhong-Xing, Wang Jing-Wen, Zhang Hong-Yu, Xiao Zhen, Zhan Si-Yan, Liu Hui-Xin, Wang Xing-Lin, Chang Ying-Jun, Wang Yu, Kong Yuan, Xu Lan-Ping, Liu Kai-Yan, Zhang Xiao-Hong, Yin Cheng-Hong, Li Yue-Ying, Wang Qian-Fei, Wang Jian-Liu, Huang Xiao-Jun, Zhang Xiao-Hui
机构信息
Peking University People's Hospital, Beijing, P.R. China.
Departments of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
出版信息
Ther Adv Hematol. 2022 Apr 29;13:20406207221095226. doi: 10.1177/20406207221095226. eCollection 2022.
BACKGROUND
The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP).
METHODS
Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone.
RESULTS
Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group ( < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8-195 days), whereas that in the combination group was 14 days (range, 6-85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone.
CONCLUSION
These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.
背景
静脉注射免疫球蛋白（IVIg）或皮质类固醇作为原发性免疫性血小板减少症（ITP）妊娠的初始治疗方法，其疗效并不理想。本研究旨在评估泼尼松联合IVIg、泼尼松或IVIg对妊娠合并免疫性血小板减少症（ITP）患者的安全性和有效性。
方法
在本观察性研究中，回顾了2010年1月1日至2020年12月31日期间在中国19个协作中心诊断为ITP的970例妊娠病例。共有513例妊娠（52.89%）未接受干预。在其余妊娠中，151例（33.04%）妊娠接受了泼尼松联合IVIg的初始治疗，105例（22.98%）妊娠仅接受IVIg治疗，172例（37.64%）妊娠仅接受泼尼松治疗。
结果
关于母体对初始治疗的反应，三个治疗组之间未发现差异（泼尼松联合IVIg组为 41.1%，泼尼松组为33.1%，IVIg组为38.1%）。然而，泼尼松联合IVIg组（4.39±2.54天）与泼尼松组（7.29±5.01天；P<0.001）以及IVIg组（6.71±4.85天）与泼尼松组之间在起效时间上存在显著差异（P<0.001）。单药治疗组泼尼松的中位使用时间为27天（范围8-195天），而联合治疗组为14天（范围6-85天）。这三个治疗组在新生儿结局方面，尤其是新生儿血小板计数方面，未发现显著差异。联合治疗组的起效时间短于泼尼松单药治疗组。联合治疗组泼尼松的应用时间短于泼尼松单药治疗组。联合治疗组分娩前血小板输注率低于单独使用IVIg组。
结论
这些发现表明，泼尼松联合IVIg可能是妊娠合并ITP患者的一种潜在联合治疗方法。
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