【摘要】 目的 通过回顾性分析12年中在我院住院治疗的19例血栓性血小板减少性紫癜(TTP)患者的临床特点,评估其临床表现、治疗和预后的相关性。方法 统计19例TTP患者的临床表现,治疗方案和治疗期间的血红蛋白(HGB)、血小板(PLT)、乳酸脱氢酶(LDH)和间接胆红素(IBIL),了解其对预后的影响。结果 19例患者均存在不同程度的PLT降低和神经精神症状,随着病程的进展,HGB逐渐下降,而发热和肾功能损害的表现程度不一。根据患者的转归将其分为好转组和死亡组,统计发现死亡组在治疗期间LDH和IBIL明显高于好转组。15例患者在治疗过程中接受血浆置换治疗,治愈率为80%,而是否使用大剂量激素冲击治疗对患者的转归没有影响。结论 ①程度不一的PLT减少和神经精神症状是TTP中最常见的临床表现;②外周血破碎红细胞的监测能为早期诊断提供证据;③在治疗过程中,LDH和IBIL水平的变化对转归的判断具有指导意义;④血浆置换是治疗TTP的有效手段,但大剂量激素治疗对预后并无影响。更多还原

【Abstract】 Objective To retrospectively analyze 19 cases with thrombotic thrombocytopenic purpura(TTP) during the past 12 years,and evaluate the relationship between the clinical features,therapy methods and prognosis.Methods In order to understand the influencing factors on the prognosis of the TTP patients,clinical data of 19 patients were analyzed,including the clinical features,therapy methods,hemoglobin,platelet,lactate dehydrogenase(LDH) and indirect bilirubin(IBIL).Results There were different degree of platelet reducing and neurological manifestations.As the disease developing,the hemoglobin decreased.The degrees of fever and renal injure were inconformity.The patients were divided into two groups according the prognosis;the LDH and IBIL of dead group were higher than favourable group in the course of therapy.Fifteen cases received plasma exchange,and survival ratio was 80%.And the glucocorticoid impact treatment had no influence on the prognosis.Conclusion ①The most common features of TTP are platelet reducing and neurological manifestations,②fractured red blood cells can provide the clue for diagnosis,③in the therapy course,the changes of LDH and IBIL can indicate prognosis,④plasma exchange is a effective treatment for TTP,and the high dose glucocorticoid therapy has no influence on prognosis.更多还原