目的探讨免疫性血小板减少性症(ITP)经糖皮质激素初治无效后进一步治疗及预后。方法对48例经糖皮质激素初治无效的ITP患者的临床资料进行回顾性分析,依据进一步治疗方案不同分为4组。A组:大剂量静脉滴注丙种球蛋白(IVIG)0.4g/(kg.d),5d;B组:长春新碱(VCR)2mg静滴每周一次,共4次。C组:环孢素A(CSA)3～4mg/(kg.d),口服6～8周;D组:脾切除或脾动脉部分栓塞。结果48例达完全反应12例(25%),总反应率达52%,长期反应率达43.75%。其中D组疗效显著高于其它3组(P<0.05)。结论糖皮质激素初治无效的ITP患者,如无禁忌症,可首先考虑脾切除或脾A栓塞治疗。对于不能耐受手术切脾的患者,可选择使用静脉丙种球蛋白、长春新碱、环孢素A等治疗也有一定疗效。 Objective To investigate further treatment and prognosis of idiopathic thrombocytopenia (ITP) after initial treatment with glucocorticoid. Methods The clinical data of 48 patients with initial ITP refractory to glucocorticoid were retrospectively analyzed and divided into 4 groups according to the different treatment regimens. Group A: IVIG 0.4g / (kg.d) for 5 days; Group B: Vincristin (VCR) 2mg intravenously once weekly for 4 times. Group C: cyclosporine A (CSA) 3 ~ 4mg / (kg.d), orally for 6 to 8 weeks; D group: splenectomy or splenic artery partial embolization. Results 48 cases of complete response in 12 cases (25%), the total response rate of 52%, long-term response rate of 43.75%. The efficacy of group D was significantly higher than the other three groups (P <0.05). Conclusion In patients with idiopathic ITP of glucocorticoids, if there are no contraindications, splenectomy or splenic embolization may be the first choice. For patients who can not tolerate surgery and splenectomy, may choose to use intravenous gamma globulin, vincristine, cyclosporine A treatment also has a certain effect.