国际输血及血液学杂志
國際輸血及血液學雜誌
국제수혈급혈액학잡지
INTERNATIONAL JOURNAL OF BLOOD TRANSFUSION AND HEMATOLOGY
2014年
5期
431-434
,共4页
紫癜,血栓性血小板减少性%回顾性研究%血浆置换%疗法
紫癜,血栓性血小闆減少性%迴顧性研究%血漿置換%療法
자전,혈전성혈소판감소성%회고성연구%혈장치환%요법
Purpura,thrombotic thrombocytopenic%Retrospective studies%Plasma exchange%Therapeutics
目的 探讨血栓性血小板减少性紫癜(TTP)患者的临床表现、辅助检查特征及治疗方法,以提高TTP的诊断和治疗水平.方法 选择2000年1月至2011年3月,于南昌大学第一附属医院确诊为TTP的12例患者为研究对象.对其临床表现、实验室检查结果、诊治及疗效进行回顾性分析.结果 12例患者中,8例为原发性TTP,4例为继发性TTP.患者典型临床表现:血小板减少、微血管性溶血性贫血、神经精神症状、发热、肾损伤的发生率分别为100％,100％,100％,75％和33％,所有患者均表现为三联征症状,仅4例患者表现为五联征.所有患者的乳酸脱氢酶(LDH)水平均升高,其中LDH水平升高超过正常值上限3倍者为7例,其LDH水平为521～2 936 U/L,平均值为1 258 U/L.5例患者给予血浆置换治疗,其中4例治愈,治愈率为80％(4/5);7例患者行血浆输注治疗,仅1例治愈,治愈率为14％(1/7).血浆置换治疗治愈率显著高于血浆输注治疗,且差异有统计学意义(P=0.045).结论 TTP患者起病多无明显诱因;临床表现以神经精神症状为主;LDH明显升高可作为早期诊断TTP的参考指标;血浆置换是TTP的首选治疗方法.
目的 探討血栓性血小闆減少性紫癜(TTP)患者的臨床錶現、輔助檢查特徵及治療方法,以提高TTP的診斷和治療水平.方法 選擇2000年1月至2011年3月,于南昌大學第一附屬醫院確診為TTP的12例患者為研究對象.對其臨床錶現、實驗室檢查結果、診治及療效進行迴顧性分析.結果 12例患者中,8例為原髮性TTP,4例為繼髮性TTP.患者典型臨床錶現:血小闆減少、微血管性溶血性貧血、神經精神癥狀、髮熱、腎損傷的髮生率分彆為100％,100％,100％,75％和33％,所有患者均錶現為三聯徵癥狀,僅4例患者錶現為五聯徵.所有患者的乳痠脫氫酶(LDH)水平均升高,其中LDH水平升高超過正常值上限3倍者為7例,其LDH水平為521～2 936 U/L,平均值為1 258 U/L.5例患者給予血漿置換治療,其中4例治愈,治愈率為80％(4/5);7例患者行血漿輸註治療,僅1例治愈,治愈率為14％(1/7).血漿置換治療治愈率顯著高于血漿輸註治療,且差異有統計學意義(P=0.045).結論 TTP患者起病多無明顯誘因;臨床錶現以神經精神癥狀為主;LDH明顯升高可作為早期診斷TTP的參攷指標;血漿置換是TTP的首選治療方法.
목적 탐토혈전성혈소판감소성자전(TTP)환자적림상표현、보조검사특정급치료방법,이제고TTP적진단화치료수평.방법 선택2000년1월지2011년3월,우남창대학제일부속의원학진위TTP적12례환자위연구대상.대기림상표현、실험실검사결과、진치급료효진행회고성분석.결과 12례환자중,8례위원발성TTP,4례위계발성TTP.환자전형림상표현:혈소판감소、미혈관성용혈성빈혈、신경정신증상、발열、신손상적발생솔분별위100％,100％,100％,75％화33％,소유환자균표현위삼련정증상,부4례환자표현위오련정.소유환자적유산탈경매(LDH)수평균승고,기중LDH수평승고초과정상치상한3배자위7례,기LDH수평위521～2 936 U/L,평균치위1 258 U/L.5례환자급여혈장치환치료,기중4례치유,치유솔위80％(4/5);7례환자행혈장수주치료,부1례치유,치유솔위14％(1/7).혈장치환치료치유솔현저고우혈장수주치료,차차이유통계학의의(P=0.045).결론 TTP환자기병다무명현유인;림상표현이신경정신증상위주;LDH명현승고가작위조기진단TTP적삼고지표;혈장치환시TTP적수선치료방법.
Objective To investigate the clinical features,auxiliary examination characteristics and treatment means of thrombotic thrombocytopenic purpura (TTP),in order to improve the level of diagnosis and treatment of TTP.Methods From January 2000 to March 2011,a total of 12 TTP patients in the First Affiliated Hospital of Nanchang University were chosen as the research objects.Their manifestations,laboratory findings,treatment and curative effect were analyzed,retrospectively.Results In these 12 TTP patients,8 cases were idiopathic TTP,4 cases were secondary TTP.The classical clinical manifestations:thrombocytopenia,microangiopathic haemolytic anaemia,neuropsychiatric symptoms,fever,renal dysfunction appeared at the percentage of 100％,100％,100％,75％ and 33％,respectively.All patients showed a triad of symptoms,but only 4 patients had the pentad.Lactate dehydrogenase (LDH) levels were increased in all patients,and 7 patients' LDH levels reached to the average of 1 258 U/L (521-2 936 U/L),which increased more than three times of upper limit of normal LDH levels.Five patients were given plasma exchange treatment,including 4 cases were cured,and the cure rate was 80％ (4/5).The rest 7 patients were treated with plasma transfusion,including 1 case were cured,and the cure rate was 14％ (1/7).The cure rate of plasma exchange was higher than that of plasma transfusion.There was statistically significant differences between cure rate of two methods (P =0.045).Conclusions TTP patients usually have no obvious pathogenesis; the main clinical manifestations is neuropsychiatric symptoms; significantly increase of LDH levels could be used as a reference indicator in the early diagnosis of TTP; and plasma exchange is the preferred treatment for TTP.
