Objective To investigate the short term efficacy of high-dose dexamethasone(Dex) in the treatment of adult primary immune thrombocytopenia (PITP). Methods Of 81 PITP patients, 69 cases(group A) were initially treated and 12'cases recieved splenectomy,who were infused Dex 40 mg/d for 4 days before surgery. The patients were divided into two groups of A(36 cases,infused Dex 40 mg/d for 4 days) and B(33 cases, treated with oral prednisone 1 mg · kg-1 · d-1 for two weeks as the controls). After one course of Dex treatment, 32 cases of group A with positive response to Dex were subdivided into two groups of Al (17 cases, given small dose of prednisone as maintenance therapy) and A2 ( 15 cases, without prednisone). Results On the 5th day after treatment, total effectiveness rate of group A was 88. 9% and the platelet count was significantly higher in group A than that in group B(79 × 109/L vs. 47 × 109/D (P<0. 01). On the 14'h day after treatment, the percentage of patients with an increase of platelet count was higher in group Al than that in group A2 (58.8% vs. 33. 3%) (P<0. 05). The patients in group C underwent the laparoscopic splenectomy uneventfully. Conclusion The high-dose Dex is effective in short term in the treatment of PITP.%目的 观察大剂量地塞米松(Dex)冲击治疗原发性免疫性血小板减少症(PITP)的近期疗效.方法 人选PITP患者81例.其中的初治PITP患者69例分为两组:A组,36例,用Dex40 mg/d静滴,连用4d为一疗程；B组33例,以泼尼松1 mg·kg1·d1,口服,连用4周作为对照.A组Dex一个疗程后,治疗有效的32例分为两个亚组:A1组,17例,再以小剂量泼尼松维持治疗；A2组,15例,不用泼尼松治疗.12例PITP复治者为脾脏切除组(C组),术前给予Dex 40 mg/d静滴,连用4d.结果 治疗后第5天,A组总有效率达88.9％,血小板数(中位数)显著高于B组(79×109/L vs.47×109/L) (P＜0.01).治疗后第14天,A1组血小板数上升患者的比例明显高于A2组(58.8％ vs.33.3％)(P＜0.05).C组患者均顺利完成腹腔镜脾脏切除术.结论 对PITP患者,大剂量Dex短期冲击治疗效果良好.
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