血栓性血小板减少性紫癜患者的临床特征及预后评价

许琳蔚.血栓性血小板减少性紫癜患者的临床特征及预后评价[J].内科急危重症杂志,2022,28(4):285-288

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DOI：10.11768/nkjwzzzz20220406

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作者	单位	E-mail
许琳蔚	汕头大学医学院第一附属医院血液一区	suyzst@126.com

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中文摘要:

目的：总结血栓性血小板减少性紫癜（TTP）患者的临床特征、治疗方式并分析其对预后的影响。方法：回顾性分析38例TTP患者的临床资料，按是否存活分为生存组和死亡组，比较2组患者的临床特征差异，治疗方式分为3种：支持治疗（成分输血、静脉免疫球蛋白等）、血浆置换、美罗华/硼替佐米联合血浆置换，利用 Kaplan-Meier法比较不同治疗方式对预后的影响，并使用Cox回归模型分析对生存有独立影响的因素。结果：38例患者中，男性20例（52.6%），女性18例（47.4%），平均年龄（47.7±17.5 ）岁，存活及死亡各19例（50%）。生存组患者的年龄较死亡组小（P=0.03）。不同治疗方式对生存时间影响存在显著性差异（P=0.004），血浆置换组及美罗华/硼替佐米联合血浆置换组疗效明显优于单纯支持治疗组（P=0.034, P=0.008）,而前2组间疗效比较，差异无统计学意义（P=0.48）。Cox回归模型结果表明，不同的治疗方式、乳酸脱氢酶水平可作为预后的独立预测因子。结论：以血浆置换为基础的治疗方式能够显著提高TTP患者的生存率，年龄较大或乳酸脱氢酶增高患者预后较差。

英文摘要:

Objective: To analyze the influence of clinical characteristics and treatment methods on prognosis of patients with thrombotic thrombocytopenic purpura (TTP). Methods: The clinical data of 38 TTP patients were retrospectively analyzed. There were three treatment options: supportive treatment (blood component transfusion and intravenous immunoglobulin); plasma exchange; plasma exchange in combination with Rituximab/Bortezomib. The differences in clinical features between survival and death groups were compared. Kaplan-Meier method was used to compare the effects of treatment methods on prognosis, and Cox regression model was used to predict the independent prognostic factors for survival. Results: Among 38 TTP patients, 20 (52.6%) were males and 18 (47.4%) were females, with an average age of 47.7±17.5 years. There were 19 survivors and 19 deaths. The average age of patients in the survival group was younger than in the death group (P=0.03). There were significant differences in survival time among different treatment regiments (P=0.004). There was significant difference between plasma exchange group or combined group and supportive group (P=0.034, P=0.008), but there was no significant difference between plasma exchange group and combined group (P=0.48). Cox regression model showed that different treatment regiments and lactate dehydrogenase (LDH) were independent prognostic factors. Conclusion: Treatment based on plasmapheresis can significantly improve the survival rate of TTP patients. The TTP patients with older age or higer LDH had a poor prognosis.