Grümayer E R, Haas O A, Panzer S, Gadner H
Klin Padiatr. 1986 Sep-Oct;198(5):414-7. doi: 10.1055/s-2008-1033899.
To date, immunoglobulin preparations and corticosteroids are the most important therapeutic principles in idiopathic thrombocytopenic purpura (ITP). Initial treatment with high-dose immunoglobulins (HD-IgG) as well as the following prednisone therapy, however, were only of short lasting success in three children with newly diagnosed ITP. Recurrent bleeding tendency tempted to combine both drugs. A desired longterm elevation of platelet counts, however, was not achieved. Administration of Anti-Rho (D) to two of the patients was also disappointing. Splenectomy which could not be postponed any longer has already led to 17 and 21 months lasting remissions in 2 patients, respectively. The third patient who required monthly single doses of HD-IgG for 6 months after surgery, is in a partial remission since 27 months now. All types of drug administration--alone, consecutive or even combined--must be considered to defer splenectomy. As experienced in our patients, however, splenectomy still seems to be justified in case even such individually adapted therapeutic approaches fail.
迄今为止，免疫球蛋白制剂和皮质类固醇是特发性血小板减少性紫癜（ITP）最重要的治疗原则。然而，在3例新诊断的ITP患儿中，大剂量免疫球蛋白（HD-IgG）初始治疗以及随后的泼尼松治疗仅取得了短期成功。反复出现的出血倾向促使联合使用这两种药物。然而，并未实现血小板计数的长期理想升高。对其中2例患者给予抗Rho（D）治疗也令人失望。无法再推迟的脾切除术已分别使2例患者获得了17个月和21个月的持续缓解。第3例患者术后6个月每月需要单剂量HD-IgG，自27个月以来处于部分缓解状态。必须考虑所有类型的药物给药方式——单独使用、连续使用甚至联合使用——以推迟脾切除术。然而，正如我们的患者所经历的那样，如果即使是这种个体化调整的治疗方法失败，脾切除术似乎仍然是合理的。
