Treatment of Idiopathic Thrombocytopenic Purpura in Adults

成人原因不明血小板減少紫斑病，為一自體免疫疾病。在許多治療方式中，腎上腺皮質激素及脾臟切除術是最有效的治療方法。為了解此二種治療的結果，我們分析了近10年內60個病例。自1983至1993年間共有60個病例於本院治療，所有的病患均予以培尼皮質醇鈉（1毫克／公斤／天）為初始治療，治療無效有（血小板數＜150,000／立方毫米）則建議接受脾臟切除手術治療。一位病患給治療前即因腦內出血死亡，故只有59位病患接受了培尼皮質醇鈉治療。其中31位（56%）病患經治療後獲得持續性（超過6個月）緩解，包括9位（17%）完全緩解（血小板數≧150000／立方毫米）。17位病患接受了脾臟切除治療，其中9位（54%）獲得持續性完全緩解，4位（23%）獲得持續性部份緩解，4位（23%）無緩解。經此分析結果，我們建議應先予以患者腎上腺皮質激素治療，五分之一的病患經此治療後可獲得持續性完全緩解。治療後未獲緩解者，應儘早施予脾臟切除術，可獲得較好的結果。大多數的病患皆不需免疫化學藥物治療。

關鍵字

成人原因不明血小板滅少紫斑病；腎上腺皮質激素；脾臟切除術；難治療的原因不明血小板減少紫斑病

並列摘要

Adult idiopathic thrombocytopenic purpura (ITP) is an immunological disorder. Some therapeutic regimens have been used for treatment, and corticosteroid (prednisolone) and splenectomy were found to be the most effective treatments. In order to understand the response to these treatments, we analyzed 60 cases with ITP during a 10-year period from 1983 to 1993, treated at tri-Service General Hospital. Corticosteroid (prednisolone 1 mg/kg/day) was the initial therapy for all ITP cases, and for patients who failed to attain and maintain adequate platelet counts (≧ 150,000/cumm) with prednisolone, a splenectomy was the treatment of choice. One patient died of intracerebral hemorrhage before treatment, and the other 59 patients were initially treated with prednisolone. Thirty-one (56%) patients had a sustained response (≧ 6 months) to prednisolone therapy, including nine (17%) patients with a complete response (platelet counts ≧ 150,000/cumm) and twnety-two (39%) with a partial response (platelet counts ＜ 150,000.cumm, but ≧ 150,000/cumm). Three patients were lost to follow up. Seventeen patients underwent splenectomy, nine (54%) of them had sustained a complete response, four (23%) had a partial response, and the other four (23%) patients were refractroy to splenectomy. We recommend that corticosteroids to be used as initial therapy for adult ITP. A splenectomy should be performed as early as possible after failure of the initial steroid treatment. Cytotoxic therapy appears to be not necessary for most of the patients.

並列關鍵字

Adult ITP (idiopathic thrombocytopenic purpura) ； corticosteroids ； splenectomy ； refractory ITP

國際替代計量

Treatment of Idiopathic Thrombocytopenic Purpura in Adults

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