内科

目的探讨糖皮质激素配合标准剂量丙种球蛋白治疗特发性血小板减少性紫癜患儿的疗效。方法选取2015年9月至2017年3月我院收治的特发性血小板减少性紫癜患儿82例，随机分成观察组和对照组，每组41例。对照组患儿仅给予糖皮质激素治疗，观察组患儿在对照组治疗的基础上联合标准剂量丙种球蛋白治疗。比较2组患儿的临床疗效和血清学指标、外周血B淋巴细胞变化情况及不良反应发生情况。结果观察组患儿治疗的总有效率为92.68%，对照组为70.73%，观察组患儿的临床疗效显著优于对照组，差异有统计学意义(P＜0.01）。治疗4周后，两组患儿的血清肿瘤坏死因子（TNF-α）、促血小板生成素（TPO）及白细胞介素-6（IL-6）水平均明显降低、IL-10水平明显升高，观察组患儿的血清TNF-α、TPO及IL-6水平低于对照组、IL-10水平高于对照组，差异均有统计学意义(P＜0.01)；两组患儿的血清PLT水平均明显升高，观察组患儿的血清PLT水平显著高于对照组，差异有统计学意义（P＜0.01）；两组患儿的B淋巴细胞测得值均明显降低，观察组患儿的测得值显著低于对照组，差异有统计学意义（P＜0.01）。观察组患儿的不良反应发生率（7.32%）显著低于对照组（24.39%），差异有统计学意义（P＜0.05）。结论应用标准剂量丙种球蛋白与糖皮质激素联合治疗特发性血小板减少性紫癜患儿临床疗效显著，可有效改善血清TNF-α、TPO、PLT及IL-10水平，降低外周血 CD19+、CD19+CD5+B淋巴细胞表达水平，治疗安全性较高。

ObjectiveTo investigate the effect of glucocorticoid and standard dose of gamma globulin on children with idiopathic thrombocytopenic purpura, and the effects on the serum level of TNF-alpha, thrombopoietin (TPO), platelet (PLT) and B lymphocyte function of peripheral blood in children. Methods82 cases of idiopathic thrombocytopenic purpura in our hospital from September 2015 to March 2017 were selected. They were randomly divided into observation group and control group, 41 cases in each group. The control group was given glucocorticoid treatment only, while the observation group was treated with standard dose gamma globulin on the basis of the control group′s treatment. The clinical efficacy, serological indexes, changes of peripheral blood B lymphocytes and adverse reactions were compared between the two groups. ResultThe total effective rate of treatment was 92.68% in the observation group and 70.73% in the control group. The clinical effect of the children in the observation group was significantly better than that of the control group, with a statistically significant difference (P＜0.01). After 4 weeks of treatment, the serum levels of TNF-alpha, TPO and IL-6 in the two groups were significantly decreased and the level of IL-10 increased significantly. The levels of serum TNF-alpha, TPO and IL-6 in the children of the observation group were lower than those of the control group and the level of IL-10 were higher than those of the control group (P＜0.01). The serum PLT level of the two groups increased significantly, and the serum PLT level of the observation group was significantly higher than that of the control group (P＜0.01). The values of B lymphocyte in the two groups were significantly lower than those in the control group. The difference was statistically significant (P＜0.05). The incidence of adverse reactions in the observation group (7.32%) was significantly lower than that in the control group (24.39), and the difference was statistically significant (P＜0.05). ConclusionThe combination of standard dose gamma globulin and glucocorticoid in the treatment of children with idiopathic thrombocytopenic purpura has a significant clinical effect. It can effectively improve the level of serum TNF-α, TPO, PLT and IL-10, and reduce the expression level of CD19+ and CD19+CD5+B lymphocytes in peripheral blood, and the treatment is more safe.