CAJ | 학술논문

目的：探讨血清免疫球蛋白是否有助于免疫性血小板减少（ITP）患者的治疗策略选择。方法收集该院2009年1月至2012年7月成人初诊ITP患者128例，所有患者予激素联合丙种球蛋白（IVIG）、环孢霉素A（CsA）、血小板生成因子（TPO）受体激动剂联合利妥昔单抗的阶梯式治疗，通过监测血清免疫球蛋白水平，分别比较小于或等于IgG、IGM 、IgA中位数组及大于中位数组的患者对治疗方案的反应率。结果血清Ig A、Ig M、Ig G水平与出血倾向并无相关性。低Ig M 水平与一线治疗抵抗相关，但对CsA及TPO受体激动剂联合利妥昔单抗治疗有反应；血清IgA水平增高往往与一线及CsA治疗抵抗相关，但对利妥昔单抗联合T PO受体激动剂治疗有反应。结论血清免疫球蛋白检测有助于成人IT P患者的治疗策略选择。
목적：탐토혈청면역구단백시부유조우면역성혈소판감소（ITP）환자적치료책략선택。방법수집해원2009년1월지2012년7월성인초진ITP환자128례，소유환자여격소연합병충구단백（IVIG）、배포매소A（CsA）、혈소판생성인자（TPO）수체격동제연합리타석단항적계제식치료，통과감측혈청면역구단백수평，분별비교소우혹등우IgG、IGM 、IgA중위수조급대우중위수조적환자대치료방안적반응솔。결과혈청Ig A、Ig M、Ig G수평여출혈경향병무상관성。저Ig M 수평여일선치료저항상관，단대CsA급TPO수체격동제연합리타석단항치료유반응；혈청IgA수평증고왕왕여일선급CsA치료저항상관，단대리타석단항연합T PO수체격동제치료유반응。결론혈청면역구단백검측유조우성인IT P환자적치료책략선택。
Objective To investigate whether the Serum Ig is help to choose the optimal treatment in patients with immune thrombocytopenia(ITP) .Methods 128 ITP patients were collected for 3 years .All of ITP patients were treated with the step-style protocol including glucocorticoid(CsA)lombied IVIG ,Ciclosporin A and TPO receptor agonist lombied rituximab .The treatment re-sponse were evaluated according the comparison between the two groups namely ≤IgG ,IGM ,IgA median and > median groups . Results There was no relationship between the bleeding and IgA 、IgM、IgG level .Low IgM level was associated with first line treatment resistance and showed the response to CsA and TPO receptor agonist lombied rituximab .High IgA level was associated with the resistance of first line and CsA treatment ,but showed no response to TPO receptor agonist lombied rituximab .Conclusion Serum Ig level is helpful for the choice of optimal treatment strategies in adult IT P patients .