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目的:分析干扰素α(interferonα,IFNα)导致的严重血小板减少性紫癜患者临床特点.方法:检索PubMed和CNKI数据库26例及我院所见1IFNα导致的严重血小板减少性紫癜,共27例,根据发病机制分成免疫性血小板减少性紫癜(immune thrombocytopenic purpura,ITP)及血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)2组,分析临床表现、实验室检查特点、治疗和转归.结果:ITP组24例主要表现为出血倾向,血小板显著减少,血小板抗体或血小板相关IgG明显升高,骨髓增生活跃,停IFNα及应用免疫抑制剂治疗后血小板于1-2 wk上升,预后较好.TTP组3例主要表现为发热,血小板显著减少,溶血性贫血,神经系统损害及肾脏损害.血浆置换是主要的治疗手段,预后差,死亡率高.ITP及TTP多发生在IFNα抗丙肝治疗过程中.结论:IFNα抗病毒过程中可能出现ITP或TTP两种严重血小板减少性紫癜的发生,须提高认识给予及时正确处理.
Objective: To analyze the clinical features of patients with severe thrombocytopenic purpura caused by interferon α (IFNα) .Methods: Twenty-seven patients with severe thrombocytopenic purpura were found from 26 PubMed and CNKI databases and 1 IFNα-induced in our hospital. The pathogenesis was divided into two groups: immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP), and the clinical manifestations, laboratory features, treatment and prognosis were analyzed.Results: ITP Twenty-four patients showed hemorrhagic tendency, significant reduction of platelet, significant increase of platelet-associated antibody or platelet-associated IgG, active bone marrow hyperplasia, increase of platelets after 1-2 weeks of treatment with IFN- 3 cases showed fever, platelet reduction, hemolytic anemia, nervous system damage and renal damage.Plasma replacement is the main treatment, the prognosis is poor, high mortality.ITP and TTP occurred in the treatment of IFNαanti-hepatitis C in the process. CONCLUSION: Two kinds of severe thrombocytopenic purpura with ITP or TTP may occur in the course of antivirus IFNα, Correct handling.