摘要
目的 观察连续2个周期大剂量地塞米松对成人新诊断的原发免疫性血小板减少症（ITP）患者的疗效及安全性.方法 将59例新诊断的ITP患者随机分为两组,地塞米松治疗组30例,地塞米松40 mg/d,连用4 d,7 d后再重复1个周期,以后不进行维持治疗;泼尼松治疗组29例,1.0～1.5 mg·kg-1·d-1口服,连用4周后逐渐减量.观察二组间的近、远期疗效和安全性.结果 近期疗效：治疗后第1、2周地塞米松组有效率明显高于泼尼松组（50.0%比24.1%,73.3%比55.2%,P值分别＜0.01和0.05）,治疗后第3周有效率仍高于泼尼松组,但差异无统计学意义（83.3%比68.9%,P＞0.05）.远期疗效：随访3个月,除第1个月地塞米松组复发率与泼尼松组差异无统计学意义（16.0%比20.0%,P＞0.05）,第2、3个月地塞米松组复发率均明显低于泼尼松组（24.0%比40.0%,32.0%比65.0%,P值分别＜0.05和0.01）.地塞米松组不良反应轻微,无1例并发感染及出现库欣综合征.结论 大剂量地塞米松治疗ITP的近、远期疗效均优于常规制量泼尼松且安全性好.
Objective To investigate the efficacy and safety of a schedule of 2 cycles＇ high-dose dexamethasone （HD-DXM） as an initial therapy in adults immune thrombocytopenia （ITP）, and compare with conventional dose prednisone therapy. Method A total of 59 newly diagnosed ITP patients were divided into 2 groups randomly. In 30 patients （ Dexamethasone group）, oral HD-DXM was administered at 40 mg/d for 4 consecutive days, repeated one week later, and then failed to maintain. In the remaining 29and then gradually tapered. Results For short-term efficacy, after 1 and 2 weeks of treatment, the response rate in Dexamethasone group was significantly higher than that in Prednisone group （50. 0% vs 24. 1%, P 〈0. 01; 73.3% vs 55.2%, P 〈0. 05 ）, while 3 weeks later, there was no remarkable difference between the two groups（83.3% vs 68.9%, P 〉 0. 05 ）, though the response rate in Dexamethasone group remained higher. For long-term effect, at the end of the 2nd and 3rd months of follow-up, the relapse rate in Dexamethasone group was significantly lower than that in Prednisone group（24. 0% vs 40. 0%, P 〈 0. 05;32.0% vs 65. 0%, P 〈 0. 01 ）, while at the end of the 1st month of follow-up, there was no significant difference（ 16. 0% vs 20. 0%, P 〉0.05 ）. In addition, it＇s well tolerated and no complications such as severe infection or Cushing syndrome were complained in Dexamethasone group. Conclusion HD-DXM possesses an advantage over conventional dose prednisone therapy in efficacy and safety.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2011年第5期401-403,共3页
Chinese Journal of Internal Medicine
基金
基金项目：国家自然科学基金（30570779、30600259、30600680、30770922、30800491、30801258、30971278）
山东省自然科学基金（ZR2009CM001）
教育部科学技术研究重点项目（109097）
卫生部临床学科重点项目
泰山学者建设工程专项经费
