目的 观察大剂量短疗程泼尼松(Pred)疗法对儿童急性免疫性血小板减少症(ITP)的疗效.方法 162例ITP患儿根据治疗方法不同随机分为大剂量静脉丙种球蛋白+甲基泼尼松龙组(IVIG+MP)、静脉丙种球蛋白组(IVIG)、甲基泼尼松龙组(MP)与Predl组.IVIG+MP组41例,采用IVIG(1g/kg,共1次)+MP[10 mg/(kg·d),每3天减半量,共9 d]冲击治疗,继之口服Pred[1.5～2.0 mg/(kg·d)],并逐渐减量维持治疗;IVIG组39例,采用丙种球蛋白(1 g/kg,共1次)冲击治疗,继之口服Pred[1.5～2.0 mg/(kg·d)]并逐渐减量维持治疗;MP组40例,采用MP[10 mg/(kg·d),每3天减半量,共9 d]冲击治疗,继之口服Pred[1.5～2.0 mg/(kg·d)]并逐渐减量维持治疗;Pred组42例,采用口服Pred[4 mg/(kg·d),共4 d]治疗后停药,无减量维持治疗.比较各组治疗前后血小板数、治疗有效率、不良反应发生率及药费支出.结果 各治疗组治疗前后血小板数及治疗有效率差异无显著性,IVIG+MP组、IVIG组、MP组治疗不良反应发生率及药费支出均高于Pred组.结论 大剂量短疗程Pred疗法治疗儿童急性ITP能有效提升血小板计数,有效率与IVIG及MP冲击治疗相比差异无显著性,不良反应少,花费低.%Objective To analyze the effects of large dose of short-course oral prednisone on the childhood acute immune thrombocytopenia ( ITP) . Methods We conducted 162 children with primary acute ITP and randomized divided them into 4 groups; IVIG + MP group, IVIG group, MP group and prednisone group. For IVIG + MP group, 41 children with ITP were treated with intravenous immunoglobulin G ( IVIG) 1 g/kg once and methylprednisolone ( MP) 10 mg/( kg · d) for 3 days, and with tapering and discontinuation of prednisone by 4 ~6 months. For IVIG group, 39 children with ITP were treated with IVIG 1g/kg once, and with tapering and discontinuation of prednisone by 4 ~ 6 months. For the MP group, 40 children with ITP were treated with MP 10 mg/( kg · d) for 3 days, and with tapering and discontinuation of prednisone by 4 ~ 6 months, For the prednisone group, 42 children with ITP were treated with oral prednisone 4 mg/( kg · d) for 4 days without tapering. Results Differences of response rates between the four groups were not significant. However, the expense and treatment-associated toxicities of IVIG + MP group, IVIG group and MP group were more than that of prednisone group. Conclusions A brief course of high-dose prednisone is an inexpensive and effective treatment for children acute ITP. It can be recommended as initial therapy for children acute ITP.
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