• 四川大學(xué)華西醫(yī)院血液內(nèi)科（成都，610041）;

【摘要】　目的　 探討影響糖皮質(zhì)激素治療特發(fā)性血小板減少性紫癜療效的主要因素。　方法　 回顧分析2008年1月-2010年7月173例特發(fā)性血小板減少性紫癜患者的臨床資料，采用χ2檢驗(yàn)及Logistic回歸分析影響糖皮質(zhì)激素療效的相關(guān)臨床因素。　結(jié)果　 單因素χ2檢驗(yàn)分析顯示性別、骨髓巨核細(xì)胞計(jì)數(shù)水平、骨髓產(chǎn)板巨核細(xì)胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平對(duì)糖皮質(zhì)激素療效的影響有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。脾臟長(zhǎng)大、抗核抗體（ANA）陽(yáng)性、補(bǔ)體C3水平降低與糖皮質(zhì)激素療效無(wú)關(guān)。多因素Logistic回歸分析顯示性別、HBsAg是影響糖皮質(zhì)激素療效的相關(guān)因素。　結(jié)論　 男性、骨髓巨核細(xì)胞計(jì)數(shù)增多、產(chǎn)板巨比例降低者對(duì)糖皮質(zhì)激素治療反應(yīng)較好。女性、血清免疫球蛋白水平異常、骨髓巨核細(xì)胞不增多者及HBsAg陽(yáng)性的患者對(duì)糖皮質(zhì)激素治療反應(yīng)相對(duì)較差。性別、HBsAg是影響糖皮質(zhì)激素療效的主要因素。
【Abstract】　Objective　 To discuss the influencing factors associated with the efficacy of glucocorticoid for idiopathic thrombocytopenic purpura.　Methods　 We retrospectively analyzed the clinical data of 173 patients with idiopathic thrombocytopenic purpura who accepted their first treatment in West China Hospital between January 2008 and July 2010. The affecting factors on the efficacy of the treatment were analyzed by means of Chi-square test and binary logistic regression analysis.　Results　 The results of Chi-square test showed that gender, bone marrow megakaryocyte count, the percentage of platelet-producing megakaryocytes, HBsAg, and the level of serum immunoglobulin could have a significant influence on the outcome of glucocorticoid treatment (P lt;0.05), while splenomegaly, positive ANA and decreasing of the level of complement C3 were not correlated with the outcome of glucocorticoid treatment. The results of multivariate logistic regression analysis showed that gender and HBsAg were correlated with the glucocorticoid treatment for patients with idiopathic thrombocytopenic purpura.　Conclusion　 Male patients, patients with increasing bone marrow megakaryocytes and patients with decreasing percentage of platelet-producing megakaryocytes have better responses to glucocorticoid, while female patients, patients with abnormal serum immunoglobulin level and patients with non-increasing number of bone marrow megakaryocytes have poor responses toward glucocorticoid treatment. Gender and HBsAg are the main influencing factors for the response to glucocorticoid.

引用本文： 余敏,廖小梅,徐才剛,牛挺. 糖皮質(zhì)激素治療特發(fā)性血小板減少性紫癜療效相關(guān)因素分析. 華西醫(yī)學(xué), 2011, 26(3): 331-334. doi: 復(fù)制

1. 　侯明, 秦平. 特發(fā)性血小板減少性紫癜的發(fā)病機(jī)制[J]. 內(nèi)科理論與實(shí)踐, 2008, 3(2): 96-102.
2. 　常大雨, 周榮富, 歐陽(yáng)建. 特發(fā)性血小板減少性紫癜的發(fā)病機(jī)制研究進(jìn)展[J]. 血栓與止血, 2009, 15(1): 36-39.
3. 　張之南, 沈梯. 血液病診斷及療效標(biāo)準(zhǔn)[M]. 3版. 北京: 科學(xué)出版社, 2007: 172-175.
4. 　鄧家棟, 楊崇禮, 楊天楹, 等. 鄧家棟臨床血液學(xué)[M]. 上海: 上?？茖W(xué)技術(shù)出版社, 2001: 120.
5. 　Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia immune thrombocytopenia[J]. Blood, 2010, 115(2): 168-185.
6. 　Smoak KA, Cidlowski JA. Mechanisms of glucocorticoid receptor signaling during inflammation[J]. Mech Ageing Dev, 2004, 125(10-11): 697-706.
7. 　Lleo A, Battezzati PM, Selmi C, et al. Is autoimmunity a matter of sex? [J]. Autoimmun Rev, 2008, 7(8): 626-630.
8. 　張國(guó)棟, 閔捷. 細(xì)胞免疫及體液免疫在ITP發(fā)生發(fā)展中的作用及其機(jī)制探討[J]. 山東醫(yī)藥, 2007, 47(17): 35-36.
9. 　范淑蘭, 王靜敏, 史麗榮. 特發(fā)性血小板減少性紫癜免疫球蛋白和T細(xì)胞亞群等動(dòng)態(tài)觀察及其臨床意義[J]. 中國(guó)當(dāng)代兒科雜志, 2000, 2(3): 167-168.
10. 　Abbasi SY, Milhem M, Zaru L, et al. A positive antinuclear antibody test predicts for a poor response to initial steroid therapy in adults with idiopathic thrombocytopenic purpura. [J]. Ann Hematol, 2008, 87(6): 459-462.
11. 　姚軍霞, 宋善俊. 病毒感染相關(guān)性血小板減少及其發(fā)生機(jī)制[J]. 國(guó)外醫(yī)學(xué)輸血及血液學(xué)分冊(cè), 2001, 24(1): 45-47.
12. 　Weksler BB. Review article: the pathophysiology of thrombocytopenia in hepatitis C virus infection and chronic liver disease[J]. Aliment Pharmacol Ther, 2007, 26(Suppl 1): 13-19.
13. 　張之南, 單淵東, 李蓉生, 等. 協(xié)和血液病[M]. 北京: 中國(guó)協(xié)和醫(yī)科大學(xué)出版社, 2004: 626-634.
14. 　陳鵠, 肖建華. 乙型肝炎病毒與特發(fā)性血小板減少性紫癜的相關(guān)性分析與研究[J]. 南華大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 39(6): 690-692.
15. 　張復(fù)華. 骨髓巨核細(xì)胞數(shù)量在激素?zé)o效免疫性血小板減少性紫癜患者中的價(jià)值[J]. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2008, 7(5): 24-25.
  1. 1. 　侯明, 秦平. 特發(fā)性血小板減少性紫癜的發(fā)病機(jī)制[J]. 內(nèi)科理論與實(shí)踐, 2008, 3(2): 96-102.
  2. 2. 　常大雨, 周榮富, 歐陽(yáng)建. 特發(fā)性血小板減少性紫癜的發(fā)病機(jī)制研究進(jìn)展[J]. 血栓與止血, 2009, 15(1): 36-39.
  3. 3. 　張之南, 沈梯. 血液病診斷及療效標(biāo)準(zhǔn)[M]. 3版. 北京: 科學(xué)出版社, 2007: 172-175.
  4. 4. 　鄧家棟, 楊崇禮, 楊天楹, 等. 鄧家棟臨床血液學(xué)[M]. 上海: 上?？茖W(xué)技術(shù)出版社, 2001: 120.
  5. 5. 　Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia immune thrombocytopenia[J]. Blood, 2010, 115(2): 168-185.
  6. 6. 　Smoak KA, Cidlowski JA. Mechanisms of glucocorticoid receptor signaling during inflammation[J]. Mech Ageing Dev, 2004, 125(10-11): 697-706.
  7. 7. 　Lleo A, Battezzati PM, Selmi C, et al. Is autoimmunity a matter of sex? [J]. Autoimmun Rev, 2008, 7(8): 626-630.
  8. 8. 　張國(guó)棟, 閔捷. 細(xì)胞免疫及體液免疫在ITP發(fā)生發(fā)展中的作用及其機(jī)制探討[J]. 山東醫(yī)藥, 2007, 47(17): 35-36.
  9. 9. 　范淑蘭, 王靜敏, 史麗榮. 特發(fā)性血小板減少性紫癜免疫球蛋白和T細(xì)胞亞群等動(dòng)態(tài)觀察及其臨床意義[J]. 中國(guó)當(dāng)代兒科雜志, 2000, 2(3): 167-168.
  10. 10. 　Abbasi SY, Milhem M, Zaru L, et al. A positive antinuclear antibody test predicts for a poor response to initial steroid therapy in adults with idiopathic thrombocytopenic purpura. [J]. Ann Hematol, 2008, 87(6): 459-462.
  11. 11. 　姚軍霞, 宋善俊. 病毒感染相關(guān)性血小板減少及其發(fā)生機(jī)制[J]. 國(guó)外醫(yī)學(xué)輸血及血液學(xué)分冊(cè), 2001, 24(1): 45-47.
  12. 12. 　Weksler BB. Review article: the pathophysiology of thrombocytopenia in hepatitis C virus infection and chronic liver disease[J]. Aliment Pharmacol Ther, 2007, 26(Suppl 1): 13-19.
  13. 13. 　張之南, 單淵東, 李蓉生, 等. 協(xié)和血液病[M]. 北京: 中國(guó)協(xié)和醫(yī)科大學(xué)出版社, 2004: 626-634.
  14. 14. 　陳鵠, 肖建華. 乙型肝炎病毒與特發(fā)性血小板減少性紫癜的相關(guān)性分析與研究[J]. 南華大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2009, 39(6): 690-692.
  15. 15. 　張復(fù)華. 骨髓巨核細(xì)胞數(shù)量在激素?zé)o效免疫性血小板減少性紫癜患者中的價(jià)值[J]. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2008, 7(5): 24-25.