CAJ | 학술논문

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.
목적 관찰련속2개주기대제량지새미송대성인신진단적원발면역성혈소판감소증(ITP)환자적료효급안전성.방법 장59례신진단적ITP환자수궤분위량조,지새미송치료조30례,지새미송40 mg/d,련용4 d,7 d후재중복1개주기,이후불진행유지치료;발니송치료조29례,1.0～1.5 mg·kg-1·d-1구복,련용4주후축점감량.관찰이조간적근、원기료효화안전성.결과 근기료효:치료후제1、2주지새미송조유효솔명현고우발니송조(50.0%비24.1%,73.3%비55.2%,P치분별＜0.01화0.05),치료후제3주유효솔잉고우발니송조,단차이무통계학의의(83.3%비68.9%,P＞0.05).원기료효:수방3개월,제제1개월지새미송조복발솔여발니송조차이무통계학의의(16.0%비20.0%,P＞0.05),제2、3개월지새미송조복발솔균명현저우발니송조(24.0%비40.0%,32.0%비65.0%,P치분별＜0.05화0.01).지새미송조불량반응경미,무1례병발감염급출현고흔종합정.결론 대제량지새미송치료ITP적근、원기료효균우우상규제량발니송차안전성호.
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.