Bulvik S, Ben-Tal O, Shimoni Z, Eldor A
Hematology Unit, Laniado Hospital, Netanya.
Harefuah. 1996 Jul;131(1-2):18-20, 71.
Most patients with chronic idiopathic thrombocytopenic purpura (TTP) show a good initial response to treatment with corticosteroids. However the disease relapses in more than 90% when steroid dosage is reduced. Recently 100% success was reported for a new therapeutic protocol in 12 patients (ranging in age from 13-60, half of them women) with chronic ITP refractory to corticosteroids or to splenectomy. They were given pulsed therapy with oral dexamethasone, 40 mg/day on 4 consecutive days each month, for 6 months. This treatment protocol was used in an attempt to avoid splenectomy. 5 patients (42%) had a complete response but 7 did not. The median follow-up in those who responded was 7 months (range 6-8). Of the 7 who did not respond, 5 had not completed treatment: 3 because of urgent splenectomy and 2 because of lack of response after 3 courses of therapy accompanied by side-effects. Most patients suffered typical corticosteroid side-effects, principally restlessness, insomnia, and withdrawal effects. These were milder and better tolerated in those treated with Dexacort solution (20 mg ampules) rather than dexamethasone tablets. Despite complete response in only 5 of the 12 patients (42%), we feel that pulsed high-dose dexamethasone is effective and should be tried in TTP refractory to conventional corticosteroid therapy, before resorting to splenectomy.
大多数慢性特发性血小板减少性紫癜（TTP）患者对皮质类固醇治疗有良好的初始反应。然而，当减少类固醇剂量时，超过90%的患者疾病会复发。最近，有报道称一种新的治疗方案在12例（年龄13 - 60岁，其中一半为女性）对皮质类固醇或脾切除术难治的慢性ITP患者中取得了100%的成功。他们接受了口服地塞米松的脉冲疗法，每月连续4天，每天40毫克，共6个月。采用该治疗方案是为了避免脾切除术。5例患者（42%）完全缓解，但7例未缓解。缓解患者的中位随访时间为7个月（范围6 - 8个月）。在7例未缓解的患者中，5例未完成治疗：3例因紧急脾切除术，2例因3个疗程治疗后无反应且伴有副作用。大多数患者出现典型的皮质类固醇副作用，主要是烦躁、失眠和戒断反应。使用地塞米松溶液（20毫克安瓿）治疗的患者这些副作用较轻且耐受性较好，而非地塞米松片剂。尽管12例患者中仅有5例（42%）完全缓解，但我们认为脉冲高剂量地塞米松是有效的，在采用脾切除术之前，对于传统皮质类固醇治疗难治的TTP患者应尝试使用。
