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目的观察新型免疫抑制剂霉酚酸酯联合强的松治疗难治性特发性血小板减少性紫癜的疗效。方法15例患者均为糖皮质激素、脾切除、长春新碱治疗无效。给予霉酚酸酯1.5~2.0g/d,分两次口服,强的松0.5mg/(kg.d)口服,连服2~4个月,服用3个月无效者停药。按1998年版张之南主编的《血液病诊断标准及疗效标准》将疗效分为显效、良效、进步和无效。结果15例患者中有5例显效(33%),3例良效,4例进步,3例无效,有效率达80%。所有患者对霉酚酸酯耐受良好,2例有轻度腹泻和恶心,1例发生白细胞减少,经减量或对症治疗完成6个月以上的治疗,副作用发生率20%。12例有效的患者1例因停药复发。结论霉酚酸酯是一个治疗难治性特发性血小板减少性紫癜有效的药物,与强的松联用疗效好,副作用少。
Objective To observe the efficacy of mycophenolate mofetil in combination with prednisone in the treatment of refractory idiopathic thrombocytopenic purpura. Methods All 15 patients were treated with glucocorticoid and splenectomy. Vincristine treatment was ineffective. Give mycophenolate 1.5 ~ 2.0g / d, orally twice a day, prednisone 0.5mg / (kg.d) orally, and even for 2 to 4 months, taking 3 months invalid disabled. According to the 1998 edition of the editor in chief of South “blood disease diagnostic criteria and efficacy standards” will be divided into effective, effective, progressive and ineffective. Results Of the 15 patients, 5 were markedly effective (33%), 3 were good, 4 were progressive, 3 were ineffective and the effective rate was 80%. All patients were well tolerated with mycophenolate mofetil, 2 with mild diarrhea and nausea, 1 with leukopenia, and 20% with side effects over 6 months after reduction or symptomatic treatment. One patient in 12 cases relapsed due to withdrawal. Conclusion Mycophenolate mofetil is an effective drug for the treatment of refractory idiopathic thrombocytopenic purpura, which has good curative effect with prednisone and few side effects.