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目的探讨小剂量激素甲泼尼龙治疗慢性特发性血小板减少性紫癜的临床疗效。方法选择2010年3月—2016年3月钦州市第一人民医院收治的慢性特发性血小板减少性紫癜患者82例,随机分为对照组和治疗组,每组41例。对照组患者采用环孢菌素A治疗;治疗组患者采用环孢菌素A与小剂量激素甲泼尼龙治疗。比较两组患者的临床疗效、症状消失时间、肾功能指标恢复正常时间、治疗时间、不良反应发生情况、用药前后肾功能相关指标和炎性递质的改善幅度等。结果治疗组总有效率高于对照组,症状消失时间、肾功能相关指标恢复正常时间、治疗时间短于对照组,不良反应发生率低于对照组,差异有统计学意义(P<0.05)。治疗前两组患者尿蛋白定量、尿RBC计数比较,差异无统计学意义(P>0.05);治疗后治疗组尿蛋白定量、尿RBC计数低于对照组,差异有统计学意义(P<0.05)。治疗前两组患者炎性递质水平比较,差异无统计学意义(P>0.05);治疗后治疗组TNF-α、IL-8、IL-6水平低于对照组,差异有统计学意义(P<0.05)。结论小剂量激素甲泼尼龙治疗慢性特发性血小板减少性紫癜的临床疗效确切,可缩短治疗时间及症状改善时间,降低炎性递质水平,有效改善肾功能指标。
Objective To investigate the clinical effect of low dose hormone methylprednisolone on chronic idiopathic thrombocytopenic purpura. Methods 82 patients with chronic idiopathic thrombocytopenic purpura admitted to First People’s Hospital of Qinzhou from March 2010 to March 2016 were randomly divided into control group and treatment group with 41 cases in each group. Patients in the control group were treated with cyclosporine A; patients in the treatment group were treated with cyclosporine A and a small dose of methylprednisolone. The clinical efficacy, the disappearance of symptoms, the recovery time of renal function, the treatment time, the incidence of adverse reactions, the indexes of renal function and the improvement of inflammatory neurotransmitters before and after treatment were compared between the two groups. Results The total effective rate of the treatment group was higher than that of the control group. The symptoms disappeared time, the index of renal function returned to normal time, the treatment time was shorter than that of the control group, the incidence of adverse reactions was lower than that of the control group, the difference was statistically significant (P <0.05). There was no significant difference in urinary protein and urinary RBC count between the two groups before treatment (P> 0.05). After treatment, urinary protein and urinary RBC count in the treatment group were lower than those in the control group (P <0.05) ). There was no significant difference in the levels of inflammatory neurotransmitters between the two groups before treatment (P> 0.05). After treatment, the levels of TNF-α, IL-8 and IL-6 in the treatment group were lower than those in the control group P <0.05). Conclusion The small dose of hormone methylprednisolone treatment of chronic idiopathic thrombocytopenic purpura clinical curative effect is exact, can shorten the treatment time and symptom improvement time, reduce the level of inflammatory neurotransmitters, and improve renal function indicators.