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目的:探讨中等剂量地塞米松治疗原发性免疫性血小板减少症患者的疗效与不良反应。方法:选取初治原发性免疫性血小板减少症患者15例,用地塞米松15 mg静脉滴注,连用3 d,复查血常规,如血小板有上升趋势且无明显出血征象可继续使用地塞米松15 mg维持3 d,后依次改为地塞米松10 mg静脉点滴3 d、5 mg静脉点滴3 d,泼尼松40 mg口服,每周减5 mg。并与我国一份前瞻性随机临床研究27例大剂量地塞米松治疗免疫性血小板减少症结果相比较。如地塞米松治疗3 d后血小板无上升趋势,且有出血征象加用静脉注射人丙种球蛋白或改用其他方案。结果:使用中等剂量地塞米松患者9 d治疗反应率为73.33%(11/15),2个月治疗反应率为66.67%(10/15),与大剂量地塞米松治疗疗效相当,且患者耐受良好,无因不良反应停药现象发生。结论:中等剂量地塞米松治疗免疫性血小板减少症患者耐受性好、不良反应少,且疗效与大剂量地塞米松治疗相当。
Objective: To investigate the efficacy and adverse reactions of moderate dose dexamethasone in patients with idiopathic thrombocytopenia. Methods: Fifteen patients with newly diagnosed primary immune thrombocytopenia were selected and treated with intravenous drip of dexamethasone (15 mg) for 3 days. The routine blood tests were performed. If the platelets had an upward trend and no obvious signs of bleeding, dexamethasone 15 mg for 3 days, followed by dexamethasone 10 mg intravenously for 3 days, 5 mg intravenously for 3 days and prednisone 40 mg orally for 5 mg weekly. And with a prospective randomized clinical trial of 27 cases of high-dose dexamethasone treatment of immune thrombocytopenia results compared. After 3 days of dexamethasone treatment, platelets did not show an upward trend, and signs of bleeding plus intravenous gamma globulin or other alternatives were used. Results: The response rate of medium dose dexamethasone was 73.33% (11/15) after 9 days. The response rate was 66.67% (10/15) after 2 months, which was equivalent to the high dose dexamethasone treatment. And the patients Well-tolerated, no withdrawal due to adverse reactions occurred. Conclusion: The moderate dose of dexamethasone in patients with immune thrombocytopenia is well tolerated, adverse reactions less, and the effect of treatment with large doses of dexamethasone quite.