激素和静脉丙球对急性ITP血小板参数的影响及临床意义

目的 　探讨静脉丙种球蛋白 (IVIg)和地塞米松 (DEX)对急性原发性血小板减少性紫癜 (ITP)血小板参数的影响及临床意义。方法 　将 6 0例急性ITP患儿随机分为DEX组和DI(DEX +IVIg)组。观察两组的平均止血时间 ;测定治疗前、后血小板计数 (PLT)、血小板压积 (PCT)、平均血小板体积 (MPV)和血小板体积分布宽度 (PDW)值的变化。结果 　DI组平均止血时间 ( 3 2± 1 1d)较DEX组平均止血时间 ( 5 4± 1 3d)明显缩短 (P <0 0 1 ) ,血小板上升速度明显增快。治疗后DEX组和DI组PLT和PCT值均逐渐升高 ,MPV和PDW值逐渐下降。但DI组PLT、PCT、MPV、PDW值变化更为显著 ,分别与DEX组比较 ,差异均有统计学意义 (P <0 0 1 )。结论 　IVIg联合DEX治疗急性ITP的疗效明显优于单用DEX ;血小板的四项参数可作为判定急性ITP病情严重程度和评价疗效的参考指标之一。

Effect of dexasone and immuglobin on platelet parameters and clinical significance in children with acute idiopathic thrombocytopenic purpura

Objective To explore the effect of dexasone(DEX) and intravenous immuglobin(IVIg) on platelet parameters and clinic significance in children with acute idiopathic thrombocytopenic purpura(ITP). Methods 60 children with acute idiopathic thrombocytopenic purpura were divided into two groups: Dex group(n=30) treated with Dex only, and DI group(n=30) treated with Dex and IVIg. The mean time of hemostasia was observed in each group. The platelet count(PLT), plateletcrit(PCT), mean platelet volum(MPV) and platelet volum distribution width(PDW) were tested at pretherapy and post-therapy respectively. Results The mean hemostatic time of DI group was significantly shortened, compared with that of DEX group respectively. The PLT and PCT in DEX group and DI group gradually increased at post-therapy, while the MPV and PDW gradually decreased, compared with those of pretherapy. At 5 day of post-therapy, PLT, PCT, MPV and PDW in DI group were significantly different from those in DEX group. Conclusion The therapeutic effect of administrating with DEX and IVIg on acute ITP was more significant than that of administrating with DEX only. The four parameters of platelet may act as one of reference markers of determination of patient's state and evaluation of therapeutic effect on acute ITP.