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原发免疫性血小板减少症研究进展

原发免疫性血小板减少症（ITP）是一种常见的出血性疾病，其发病机制仍不十分清楚。现有治疗方案在ITP的治疗中取得一定的疗效，如糖皮质激素、静脉注射免疫球蛋白以及脾切除等，但仍有较多患者面临复发难治的问题。现将近年ITP发病机制、诊断和治疗等方面的研究进展作一综述。

大剂量地塞米松冲击治疗成人重症免疫性血小板减少症近期疗效观察

目的观察大剂量地塞米松静脉冲击治疗重症免疫性血小板减少症（ITP）的近期疗效及安全性。 方法2010年1月－2013年6月,采用大剂量地塞米松短期（40 mg/d×4 d）静脉冲击治疗80例重症ITP患者，观察血小板计数（BPC）、出血症状的变化及药物不良反应。 结果冲击治疗4 d，出血症状减轻，活动性出血消失，BPC都有升高，完全反应率33.75%，总有效率77.50%。18例延长疗程3 d后，总有效率提高到100.00%，完全反应率47.50%。只有1例出现轻度水钠潴留，无高血压、高血糖、电解质紊乱及严重感染发生。 结论大剂量地塞米松冲击治疗ITP，安全有效、不良反应少。

慢性/复发性原发免疫性血小板减少症合并抗 O 升高二例

Expression and clinical significance of immune cell subsets in elderly patients with primary immune thrombocytopenia

Objective To investigate the expression and clinical significance of T lymphocyte subsets, natural killer (NK) cells and CD19+ B cells in the elderly with primary immune thrombocytopenia (ITP) before and after treatment. Methods The elderly ITP patients diagnosed and treated in the Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (preparatory stage) between January 2014 and June 2019 were retrospectively selected as the observation group. The healthy elderly in the same period were selected as the control group. According to the treatment, the observation group was divided into effective group and ineffective group. The expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells were observed and analyzed. Results A total of 75 subjects were included, including 35 in the observation group and 40 in the control group. The total effective rate was 85.71% (30/35). Before treatment, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were lower than those in the control group (P<0.05). There was no significant difference in other indexes between the two groups (P>0.05). After treatment, except for CD8+, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were higher than those before treatment (P<0.05). The expression levels of NK cells and CD19+ B cells were lower than those before treatment (P<0.05). The expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the effective group were higher than those before treatment (P<0.05), while the expression level of CD19+ B cells was lower than that before treatment (P<0.05). There was no significant difference in other indexes before and after treatment (P>0.05). There was no significant difference in the expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells in the ineffective group before and after treatment (P>0.05). Conclusions T lymphocyte subsets are abnormal in elderly ITP patients. The immune abnormality of T lymphocyte may be one of the reasons for elderly patients with ITP. With the improvement of therapeutic effect, immune cell subsets have also been improved.