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目的 研究糖皮质激素治疗系统性红斑狼疮 (SLE)伴血小板减少症的近远期疗效 ,分析影响疗效的相关因素。方法 对 1999— 2 0 0 1年确诊为SLE伴中、重度血小板减少 (血小板 <5 0× 10 9 L) 82例患者进行回顾性分析及随访 ,研究糖皮质激素治疗血小板减少症的近远期疗效及与疾病活动性、骨髓增生程度、血小板抗体 (PAIg)及抗心磷脂抗体 (ACLA)水平因素的相关性。 结果 中、大剂量组 (泼尼松 0 5～ 1mg·kg- 1 ·d- 1 )与超大剂量激素组 (泼尼松≥ 2mg·kg- 1 ·d- 1 )其近期 (4～ 8周 )疗效及远期 (12～ 2 4周 )疗效差异均无显著性 (P >0 0 5 )。具有高活动性组的治疗总有效率优于低活动性组 (P <0 0 1)。骨髓增生活跃组治疗总有效率优于增生低下组的有效率 (P <0 0 5 )。血小板抗体阳性组与阴性组治疗的有效率差异无显著性 (P >0 0 5 )。ACLA阳性组与阴性组的治疗总有效率差异无显著性 (P >0 0 5 )。结论 ①激素治疗SLE伴中、重度血小板减少症以相当于泼尼松 0 5～ 1mg·kg- 1 ·d- 1 为宜 ,大剂量激素的主要副作用是增加感染 ;②活动性高及骨髓增生度好的患者对治疗的反应好。
Objective To study the short-term and long-term effects of glucocorticoids on treating systemic lupus erythematosus (SLE) with thrombocytopenia and to analyze the related factors that affect the curative effect. Methods A retrospective analysis and follow-up of 82 patients with moderate and severe thrombocytopenia (platelets <50 × 10 9 L) diagnosed as SLE from 1999 to 2001 were conducted to investigate the short-term and long-term effects of glucocorticoid therapy on thrombocytopenia Efficacy and disease activity, the degree of myeloproliferation, platelet antibody (PAIg) and anti-cardiolipin antibodies (ACLA) levels of the factors. Results In the high-dose group (prednisone 0 5 ~ 1 mg · kg -1 · d -1) and super-high-dose hormone group (prednisone ≥ 2 mg · kg -1 · d -1) ) Efficacy and long-term (12 ~ 24 weeks) no significant difference in efficacy (P> 0.05). The total effective rate of patients with high activity group was better than that of low activity group (P <0.01). The total effective rate of active treatment in myeloid hyperplasia group was better than that in hyperplastic subgroup (P <0.05). There was no significant difference in the effective rate of platelet antibody positive and negative group (P> 0.05). The total effective rate of ACLA-positive group and negative group was no significant difference (P> 0.05). Conclusion ① Hormone treatment of SLE with moderate and severe thrombocytopenia is equivalent to prednisone 0 5 ~ 1mg · kg-1 · d-1 is appropriate, the main side effects of high-dose hormone is to increase the infection; ② high activity and myeloproliferation Good patients respond well to treatment.