【摘要】 目的　评价静脉输注大剂量丙种球蛋白（ＩＶＩＧ）结合脾切除术治疗难治性血小板减少性紫癜的疗 效。方法　４３例均为对糖皮质激素耐药、依赖、慎用的难治性ＩＴＰ患者，术前给予丙种球蛋白４００ｍｇ／ｋｇ·ｄ，连用５ 天，用药后１０ｄ内血小板升至５０×１０９／Ｌ以上者实施脾切除术。个别病例血小板未达到此数值，术前１～２ｈ 输机采 血小板１～２ｕ，然后进行手术。结果应用ＩＶＩＧ后，３４例（７９％）血小板升至５０×１０９／Ｌ以上，其余病例血小板亦有 不同程度上升。脾切除近期疗效（术后２个月～１年）：４３例均达临床缓解，其中１３例复发，经用激素治疗后，１２例 再次达到临床缓解，１例无效。临床缓解率９７．７％。脾切除远期疗效（术后１年以上）：观察１年以上有３５例，均达 到临床缓解。其中基本治愈１８例（５１．４％），７例复发，６例经过激素治疗再次达到临床缓解，１例无效。临床缓解率 ９７．１％。结论　静脉输往大剂量丙种球蛋白是一个有效的术前提升血小板的治疗方法，而脾切除术可使大部分难治性ＩＴＰ患者达到临床缓解。更多还原

【Abstract】 Objective To evaluate the curative effect of intravenous IgG(IVIG)combined with splenectomy on refractory idiopathic thrombocytopenic purpura(ITP). Methods Forty-three patients with refractory ITP were treated with IVIG at a dosage of 400mg/kg. d for 5 days and received splenectomy 1-2h 1-2h after the thrombocyte counts of them rose to above 50 ×109/L. Individual patient whose . counts was less than 50 × １０９／L also received splenectomy 1-2h after being transfused with 1-1u of thrombocyte collected by blood sampler.Results After being treated with IVIG,the thrombocyte counts of 34 of the 43 patients(79%) rose to above 50×109/L,and the counts of the rest patients also rose at different degrees. All the 43 patients reached clinical remission 2 months to 1 year after splenectomy,and 12 of the 13 recurrent patients reached clinical remission again after being treated with hormone. All the 35 patients for more than 1 year after splenectomy reached clinical remission, and 18 of them were basically cured(51 .4%). Recurrences were observed in 7 of the 35 patients, however,6 of them reached clinical remission again after being treated with hormone .The short- and long-term remission remission were 97.7% and 97. 1% respectively.Conclusion Large dose of IVIG is effective in rising thrombocyte counts,and most of the patients with refractory ITP reach clinical remission after splenectomy.更多还原