[1]刘新颜,蔡晶娟.糖皮质激素联合不同剂量丙种球蛋白治疗儿童原发性免疫性血小板减少症疗效观察[J].新乡医学院学报,2021,38(9):872-875.[doi:10.7683/xxyxyxb.2021.09.015]
　LIU Xinyan,CAI Jingjuan.Effect of glucocorticoid combined with different doses of gamma globulin in the treatment of primary immune thrombocytopenia in children[J].Journal of Xinxiang Medical University,2021,38(9):872-875.[doi:10.7683/xxyxyxb.2021.09.015]
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糖皮质激素联合不同剂量丙种球蛋白治疗儿童原发性免疫性血小板减少症疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年9
页码:
872-875
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
Effect of glucocorticoid combined with different doses of gamma globulin in the treatment of primary immune thrombocytopenia in children
作者:
刘新颜; 蔡晶娟
（成都儿童专科医院内二科，四川　成都　610000）
Author(s):
LIU Xinyan; CAI Jingjuan
(Department of Internal Medicine,Chengdu Children′s Hospital,Chengdu 610000,Sichuan Province,China)
关键词:
原发性免疫性血小板减少症; 糖皮质激素; 丙种球蛋白; 免疫功能
Keywords:
primary immune thrombocytopenia glucocorticoid gamma globulin immune function
分类号:
R558+2
DOI:
10.7683/xxyxyxb.2021.09.015
文献标志码:
A
摘要:
目的　探讨糖皮质激素联合不同剂量丙种球蛋白治疗儿童原发性免疫性血小板减少症（ITP）的临床效果。方法　选择2016年1月至2019年12月成都儿童专科医院收治的86例初诊原发性ITP患儿为研究对象，根据治疗方案将患儿分为A组（n=24）、B组（n=35）和C组（n=27）。A组患儿给予注射用甲泼尼龙琥珀酸钠治疗， B组患儿在A组治疗基础上给予丙种球蛋白400 mg·kg-1·d-1，连续治疗3 d；C组患儿在A组治疗基础上给予丙种球蛋白1 g·kg-1·d-1，连续治疗2 d。比较3组患儿皮肤黏膜出血消失时间、血小板（PLT）开始升高时间、PLT恢复正常时间、住院时间及不良反应。分别于治疗前、治疗结束后检测患儿CD4+T细胞亚群调节性T细胞（Treg）、辅助性T细胞（Th）17、Th1和Th2细胞水平，并计算Th1/Th2、Treg/Th17；治疗结束后根据患儿2次PLT检测结果判断治疗效果。结果　3组患儿皮肤黏膜出血消失时间、PLT开始升高时间、PLT恢复正常时间和住院时间比较差异均无统计学意义（P＞0.05）。治疗前3组患儿Th1细胞、Th2细胞、Treg细胞、Th17细胞水平及Th1/Th2、Treg/Th17比较差异无统计学意义（P＞0.05）。A组患儿治疗后Th1/Th2显著低于治疗前，Treg细胞和Th17细胞水平显著高于治疗前（P<0.05）；B组和C组患儿治疗后Th2细胞、Treg细胞和Th17细胞水平显著高于治疗前，Th1/Th2显著低于治疗前（P<0.05）；治疗后，B组和C组患儿Th2细胞水平显著高于A组（P<0.05），C组患儿Th1/Th2显著低于A组和B组（P<0.05），C组患儿Treg细胞水平显著高于A组和B组（P<0.05）。A组、B组和C组患儿治疗总有效率分别为41.7%（10/24）、68.6%（24/35）、74.1%（20/27），B组和C组患儿治疗总有效率显著高于A组（χ2=4.221、5.509，P<0.05），B组与C组患儿治疗总有效率比较差异无统计学意义（χ2=0.878，P＞0.05）。A组、B组和C组患儿不良反应发生率分为 12.5%（3/24）、11.4%（4/35）、11.1%（3/27），3组患儿不良反应发生率比较差异无统计学意义（χ2=0.026，P＞0.05）。结论　糖皮质激素联合丙种球蛋白可以有效改善ITP患儿的免疫功能，提高治疗效果；未发现丙种球蛋白2种用药方案的临床疗效的显著差异，尚有待进一步研究。
Abstract:
Objective　To investigate the clinical effect of glucocorticoid combined with different doses of gamma globulin in the treatment of primary immune thrombocytopenia (ITP) in children.Methods　Eighty-six newly diagnosed children with primary ITP admitted in Chengdu Children′s Hospital from January 2016 to December 2019 were selected as the research subjects.The children were divided into group A (n=24),group B (n=35) and group C (n=27) according to the therapeutic schedule.The children in the group A were treated with methylprednisolone sodium succinate for injection.On the basis of treatment in group A,the children in the group B were treated with gamma globulin 400 mg·kg-1·d-1 for three days,while the children in the group C were treated with gamma globulin 1 g·kg-1·d-1 for two days.The time of skin and mucosal bleeding disappearance,the time of platelet (PLT) rising,the time of PLT returning to normal,the hospitalization time and adverse reactions were compared among the three groups.The levels of CD4+ T cell subsets including regulatory T cells (Treg),helper T cells (Th) 17,Th1 and Th2 cells were measured before and after treatment,and the Th1/Th2 and Treg/Th17 were calculated.The treatment effect was judged according to the results of two PLT tests after treatment.Results　There was no significant difference in the time of skin and mucosal bleeding disappearance,the time of PLT rising,the time of PLT returning to normal and the hospitalization time among the three groups (P＞0.05).There was no significant difference in the levels of Th1,Th2,Treg,Th17 cells,Th1/Th2 and Treg/Th17 among the three groups before treatment (P＞0.05).In the group A,the Th1/Th2 after treatment was significantly lower than that before treatment,and the levels of Treg and Th17 cells were significantly higher than those before treatment (P<0.05).In the group B and group C,the levels of Th2,Treg and Th17 cells after treatment were significantly higher than those before treatment,and the Th1/Th2 was significantly lower than that before treatment (P<0.05).After treatment,the level of Th2 cells in the group B and group C was significantly higher than that in the group A (P<0.05),the Th1/Th2 in the group C was significantly lower than that in the group A and group B (P<0.05),and the level of Treg cells in the group C was significantly higher than that in the group A and group B (P<0.05).The total effective rate in the group A,group B and group C was 41.7% (10/24),68.6% (24/35) and 74.1% (20/27),respectively.The total effective rate in the group B and group C was significantly higher than that in the group A (χ2=4.221,5.509 P<0.05),but there was no significant difference in the total effective rate between the group B and group C (χ2=0.878,P＞0.05).The incidence of adverse reactions in the group A,group B and group C was 12.5% (3/24),11.4% (4/35) and 11.1% (3/27),respectively.There was no significant difference in the incidence of adverse reactions among the three groups (χ2=0.026,P＞0.05).Conclusion　Glucocorticoid combined with gamma globulin can effectively improve the immune function and therapeutic effect in children with ITP.There was no significant difference in the clinical efficacy between the two regimens of gamma globulin,which needs to be further studied.

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更新日期/Last Update: 2021-09-05