目的：探讨联合使用免疫抑制剂对难治性 ITP 患者巨核细胞相关 IgG 水平的影响及疗效。方法将18例难治性 ITP 患者随机分为联合治疗组和单药治疗组。联合治疗组先予2至3种静脉药物治疗3~5d,血小板值上升后联合使用2至3种不同组合的免疫抑制剂；单药治疗组先予甲基强的松龙或静脉免疫球蛋白滴注3~5d,血小板值上升后单用一种免疫抑制剂治疗。维持治疗3~6个月,随访4~24个月。运用免疫荧光法观察上述对象治疗前后巨核细胞相关IgG 情况。结果两组对象治疗后巨核细胞相关 IgG 水平均明显降低,且联合治疗组明显低于单药治疗组,差异有统计学意义(P <0.05)；联合治疗组总有效率88.9%,高于对照组的33.3%,差异有统计学意义(P <0.05)。结论联合使用免疫抑制剂对难治性 ITP 患者巨核细胞相关抗体水平有明显降低作用,同时能取得较好的临床疗效。%Objective To evaluate the effects on megakaryocyte-associated-IgG and its clinic effects of combination im-munosuppressant therapy for patients with refractory ITP . Method 18 patients with refractory ITP were randomly divided into combination treatment group and single treatment group. The former were treated with two or three kinds of intravenous drug agents for 3 or 5 days, then took different combined chemotherapy consist of two or three kinds of immunosuppressive agents after platelet count increasing quickly. The latter were treated with methylprednisolone or IVIG for 3 ~ 5 days, then took only one immunosup-pressive agents after platelet count increasing . The treatment maintained for 3 ~ 6 months and the duration of follow-up was 4 ~24months. We used Immunoflourescence to detect megakaryocyte-associated-IgG of patients. Result Megakaryocyte-associated-associated-IgG decreased obviously both in two groups, which of combination treatment group was much lower than that of single treat-ment group (P < 0. 05). The total effective rate of combination treatment group was 88. 9% , higher than that of single treatment group (The total effective rate of single treatment group was 33. 3% ) (P < 0. 05). Conclusion Combination chemotherapy could decrease megakaryocyte-associated-IgG of patients with refractory ITP obviously which is a useful approach for treatment.
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