Autoimmune (idiopathic) thrombocytopenic purpura
Autoimmune (idiopathic) thrombocytopenic purpura
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DOI：
10.1016/s0140-6736(05)63426-5
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发表时间：
1997-08
期刊：
影响因子：
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通讯作者：
S. Hauser
中科院分区：
文献类型：
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作者：
S. Hauser
SIR-I希望对Simon Karpatkin（5月24日，1531页）关于自身免疫性血小板减少性紫癜的综述提出一些额外的观点。脾切除术被推荐为成人和儿童慢性自身免疫性血小板减少性紫癜的首选治疗方法，尽管Reid2报道儿童自发性长期缓解率高，发病率低。在这项研究中，没有死亡可归因于慢性特发性血小板减少性紫癜。里德研究结果的外推表明，61%的儿童15年的自发性缓解率。如果考虑到脾切除术的并发症，支持治疗可能与儿童脾切除术一样有效。另外，患者的生活方式和个人偏好是决定是否进行脾切除术的重要因素。骑摩托车或喜欢骑马的青少年可能表明脾切除术是一个更合适的选择，而不是对血小板计数持续低的活动进行必要的限制。Karpatkin提到对皮质类固醇治疗的良好反应是脾切除术良好反应的指标，但没有讨论对免疫球蛋白的反应。Law和他的同事报道，对大剂量静脉注射免疫球蛋白的反应是脾切除术后后续反应的一个很好的预测指标。在21例免疫性血小板减少性紫癜患者中，19例静脉注射免疫球蛋白有良好反应的患者在脾切除术后得到缓解，但没有对静脉注射免疫球蛋白无反应的患者对脾切除术有反应。脾切除术是慢性自身免疫性血小板减少性紫癜的有效治疗方法，但不一定适用于所有患有这种疾病的儿童。
SIR—I wish to raise some additional points in response to Simon Karpatkin’s (May 24, p 1531) 1 review of autoimmune thrombocytopenic purpura. Splenectomy has been recommended as the preferred treatment for chronic autoimmune thrombocytopenic purpura in adults and children, although Reid2 has reported a high rate of spontaneous long-term remission with low morbidity in children. In this study there were no deaths attributable to chronic idiopathic thrombocytopenic purpura. Extrapolation of Reid’s findings indicate a rate of 15–year spontaneous remission in 61% of children. Supportive management may be as effective as splenectomy in children if the complications of splenectomy are taken into account. Alternatively, lifestyle and the personal preference of the patient are important in deciding whether to proceed to splenectomy. A teenager who rides a motorbike or enjoys horse riding may indicate that splenectomy is a more suitable option than the necessary restriction on activity required with persistently low platelet counts. Karpatkin mentions the favourable response to corticosteroid therapy as an indicator of good response to splenectomy, but does not discuss response to immunoglobulin. Law and colleagues3 reported that response to high-dose intravenous immunoglobulin is a good predictor of subsequent response after splenectomy. Of 21 patients with immune thrombocytopenic purpura, 19 who had a good response to intravenous gammaglobulin attained remission after splenectomy, but no patient without response to intravenous immunoglobulin responded to splenectomy. Splenectomy is an effective treatment for chronic autoimmune thrombocytopenic purpura, but may not necessarily be indicated in all children with this condition.