Tarantino M D, Madden R M, Fennewald D L, Patel C C, Bertolone S J
University of Louisville, Department of Pediatrics, Division of Pediatric Hematology/Oncology and Kosair Children's Hospital, Louisville, Kentucky, USA.
J Pediatr. 1999 Jan;134(1):21-6. doi: 10.1016/s0022-3476(99)70367-7.
To evaluate the effectiveness of initial treatment of children with acute immune thrombocytopenic purpura (ITP) with anti-D immune globulin (anti-D) or pooled IgG immune globulin (IVIg).
The medical charts of 33 children diagnosed with acute ITP from May 1995 to October 1997 were reviewed. Patient data were eligible for analysis if, for the new diagnosis of acute ITP, the patient had received either anti-D at 45 to 50 microg/kg (WinRho SD, NABI) or IVIg at 0.8 to 1 g/kg (Gammagard SD, Baxter-Highland). The platelet response time for each treatment group was compared by the Mann-Whitney U test.
Time to achieve a platelet count >/=20 x 10(9 )/L (20,000/mm3 ) was 1.54 +/- 0.51 days in the IVIg group (n = 13) and 1.26 +/- 0.82 days in the anti-D group (n = 14) (P =.34). Time to achieve a platelet count >/=40 x 10(9 )/L (40,000/mm3 ) was 1.77 +/- 0.74 and 1.49 +/- 1.01 days for the IVIg and anti-D groups, respectively (P =.32). Children given IVIg were hospitalized for 2.1 +/- 0.87 days, whereas those given anti-D were hospitalized for 1.94 +/- 1.08 days. A net decrease in hemoglobin concentration was observed after receipt of IVIg (9.1 +/- 7.3 g/L [0.91 +/- 0.73 g/dL]) and after anti-D therapy (4.5 +/- 10.3 g/L [0.45 +/- 1.03 g/dL], P =.23). No patient required intervention for hemolysis.
In this retrospective analysis anti-D was as effective as IVIg for the treatment of acute ITP in children. However, randomized, controlled trials are needed to establish the role of anti-D in the treatment of acute ITP in children.
评估用抗D免疫球蛋白（抗D）或静脉注射丙种球蛋白（IVIg）对急性免疫性血小板减少性紫癜（ITP）患儿进行初始治疗的有效性。
回顾了1995年5月至1997年10月期间33例诊断为急性ITP的患儿的病历。如果患儿因新诊断的急性ITP接受了45至50微克/千克的抗D（WinRho SD，NABI）或0.8至1克/千克的IVIg（Gammagard SD，Baxter-Highland）治疗，则其患者数据符合分析条件。通过Mann-Whitney U检验比较每个治疗组的血小板反应时间。
IVIg组（n = 13）达到血小板计数≥20×10⁹/L（20,000/mm³）的时间为1.54±0.51天，抗D组（n = 14）为1.26±0.82天（P = 0.34）。IVIg组和抗D组达到血小板计数≥40×10⁹/L（40,000/mm³）的时间分别为1.77±0.74天和1.49±1.01天（P = 0.32）。接受IVIg治疗的患儿住院2.1±0.87天，而接受抗D治疗的患儿住院1.94±1.08天。接受IVIg治疗后（9.1±7.3克/升[0.91±0.73克/分升]）和抗D治疗后（4.5±10.3克/升[0.45±1.03克/分升]，P = 0.23）观察到血红蛋白浓度净下降。没有患者需要进行溶血干预。
在这项回顾性分析中，抗D在治疗儿童急性ITP方面与IVIg一样有效。然而，需要进行随机对照试验来确定抗D在儿童急性ITP治疗中的作用。
