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目的探讨丙种球蛋白联合肾上腺皮质激素治疗儿童急性特发性血小板减少性紫癜(ITP)的临床疗效。方法选取急性ITP患儿72例作为研究对象,随机分为对照组和研究组,每组36例。对照组患儿静脉注射地塞米松磷酸钠注射液1.5 mg/(kg·d),5 d后改为口服醋酸泼尼松片2 mg/(kg·d),疗程为4周。研究组患儿则在对照组基础上给予静脉滴注丙种球蛋白200 mg/(kg·d)治疗,连续治疗5 d。监测两组患儿的治疗前及治疗后14 d血小板参数水平,评估两组患儿的临床疗效。记录两组患儿的血小板上升时间、血小板恢复正常时间、出血停止时间及住院时间,观察两组患儿不良反应。结果研究组患儿治疗后14 d的血小板计数和血小板压积分别为(265.72±51.42)×109/L和(3.25±1.32)%,高于对照组的(208.69±44.56)×109/L和(2.43±1.28)%,差异有统计学意义(P<0.05);研究组患儿治疗后14 d的MPV和PDW分别为(8.72±1.23)f L和(10.59±1.56)%,低于对照组的(10.12±1.34)f L和(14.23±2.14)%,差异有统计学意义(P<0.05);研究组患儿总有效率为94.44%,高于对照组(72.22%),差异有统计学意义(P<0.05)。研究组血小板上升时间、血小板恢复正常时间、出血停止时间和住院时间分别为(1.56±0.79)d、(4.38±2.23)d、(3.02±1.05)d和(9.87±1.26)d,低于对照组的(3.76±1.21)d、(8.64±3.45)d、(4.13±1.18)d和(13.28±1.84)d,差异有统计学意义(P<0.05);两组患儿的不良反应发生率比较,差异未见统计学意义(P>0.05)。结论丙种球蛋白联合肾上腺皮质激素治疗急性ITP,可有效改善患儿血小板参数水平和出血症状,且不良反应少,值得临床应用。
Objective To investigate the clinical efficacy of gamma globulin combined with adrenocorticotropic hormone in children with acute idiopathic thrombocytopenic purpura (ITP). Methods Seventy-two children with acute ITP were selected as study subjects and randomly divided into control group and study group with 36 cases in each group. The control group received intravenous dexamethasone sodium phosphate injection 1.5 mg / (kg · d), 5 days later changed to oral prednisone acetate tablets 2 mg / (kg · d) for 4 weeks. The study group was given intravenous infusion of gamma globulin 200 mg / (kg · d) on the basis of the control group, continuous treatment for 5 days. The two groups of children before and after treatment to monitor platelet parameters 14 days to assess the clinical efficacy of two groups of children. The platelet rise time, platelet recovery time, bleeding stop time and hospital stay in both groups were recorded. Adverse reactions were observed in both groups. Results The platelet count and platelet pressure of the 14th day after treatment in the study group were (265.72 ± 51.42) × 109 / L and (3.25 ± 1.32)%, respectively, higher than those in the control group (208.69 ± 44.56) × 109 / L and (2.43 ± 1.28)% respectively, the difference was statistically significant (P <0.05). The MPV and PDW in the study group were (8.72 ± 1.23) f L and (10.59 ± 1.56)% on the 14th day after treatment, (10.12 ± 1.34) f L and (14.23 ± 2.14)%, respectively, the difference was statistically significant (P <0.05). The total effective rate of the study group was 94.44%, which was higher than that of the control group (72.22%), the difference was Statistical significance (P <0.05). The platelet rise time, platelet recovery time, bleeding stop time and hospital stay in study group were (1.56 ± 0.79) d, (4.38 ± 2.23) d, (3.02 ± 1.05) d and (9.87 ± 1.26) d, respectively, (3.76 ± 1.21) d, (8.64 ± 3.45) days, (4.13 ± 1.18) days and (13.28 ± 1.84) days, respectively. The difference was statistically significant (P <0.05). The incidence of adverse reactions Comparison, the difference was not statistically significant (P> 0.05). Conclusions The treatment of acute ITP with gamma globulin and adrenocorticotropic hormone can effectively improve the platelet parameters and hemorrhage in children with less adverse reactions and is worthy of clinical application.