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Effectiveness of Platelet Increasing Capsule Combined with Hormone in Treating Idiopathic Thrombocytopenic Purpura: A Systematic Review

Objective　To systematically evaluate the effectiveness of platelet increasing capsule combined with hormone in treating idiopathic thrombocytopenic purpura (ITP). Methods　Randomized controlled trials (RCTs) of ITP treated by platelet increasing capsule combined with hormone were electronically searched from PubMed (1966 to 2012), The Cochrane Library (CENTRAL, Issue 3, 2012), CBM (1978 to 2012), CNKI (1979 to 2012), WanFang Data (1998 to 2012), and VIP (1991 to 2012). References of included studies were also retrieved. The literature was independently screened according to exclusion and inclusion criteria by two researchers independently and meta-analysis was conducted using RevMan 5.1 software after data extraction and quality assessment. Results　10 RCTs were included involving 588 patients. The results meta-analysis showed that, the group which was treated by platelet increasing capsule combined with hormone was superior to the hormone alone group in the aspects of overall effectiveness rate (RR=1.18, 95%CI 1.06 to 1.32, P=0.003), the significant effectiveness rate (RR=1.57, 95%CI 1.29 to 1.91, Plt;0.000 01), blood platelet count (MD=21.54, 95%CI 13.85 to 29.23, Plt;0.000 01), and the recurrence rate (RR=0.49, 95%CI 0.34 to 0.69, Plt;0.000 01) which was lower. Conclusion　Current evidence has showed that platelet increasing capsule combined with hormone in treating ITP is better than hormone alone. However, more high quality RCTs are needed to verify the above conclusion in future.

Clinical Observation of Thrombocytopenia Induced by Heparin for Sealing Venous Remaining Needle

目的　探讨静脉留置针封管用肝素诱导的血小板减少症（HIT）的临床特点。 方法　分析2010年1月－2011年12月，在1 215例静脉留置针肝素封管患者中发生的14例HIT患者的临床表现，血小板（PLT）、HIT抗体的变化，氯吡格雷、阿加曲班、地塞米松等治疗的结果。 结果　1 215例患者中：发生HIT 14例，发生率1.15%；HIT并血栓形成综合征4例，发生率0.33%。14例HIT患者中：经典型12例，占85.7%。出血7例，发生率50.0%，其中1级、2级出血发生率分别为42.9%（6/14）、7.1%（1/14），分别占出血的85.7%（6/7）、14.3%（1/7）。血栓形成4例，发生率28.6%，其中静脉血栓3例，占血栓形成的75.0%。14例均发生于肝素封管后第1～14天，其中第6～7天8例，占57.1%。PLT降低到最低值的时间为肝素封管后2～10 d内，其中2～5 d内13例，占92.9%。PLT降低的最低值为（1.81～101）×109/L，其中PLT（20～70）×109/L12例，占85.7%；PLT降至最低时下降的比值为51.1%～90.1%，其中50%～80%10例、占71.4%。1例至28 d死亡时血小板没有恢复至肝素封管前水平，其余13例患者PLT减少持续时间5～13 d，其中5～10 d 10例，占76.9%。14例（100%）HIT患者HIT抗体阳性，其中13例（92.9%）在PLT开始减少时即阳性，1例在PLT减少2周后呈阳性。14例HIT患者中12例（85.8%）痊愈，1例（7.1%）脑血栓后遗症，1例（7.1%）死于急性肺栓塞。 结论　静脉留置针封管用肝素可导致HIT，PLT减少及血栓、HIT抗体是诊断的可靠依据。及时停用肝素，必要时抗凝、抗PLT、类固醇激素治疗效果好，部分患者进展快，死亡率高。

Clinical Observation of Splenectomy on Chronic Idiopathic Thrombocytopenic Purpura

ObjectiveTo study the results of splenectomy in patients with idiopathic thrombocytopenic purpura. MethodsSeven patients who failed to respond to conservative management were treated with splenectomy and followed up for 6 months to 8 years (1990～1999).ResultsThe presplenectomy patients had symptoms of bleeding and their platelet count on average was 32×109/L. The 3th,7th day and 1th,2th, 6th month after splenectomy, the average platelet count was 191×109/L,354×109/L,317×109/L,200×109/L and 151×109/L respectively. Their platelet recovered to normal during a week in 7 cases (≥100×109/L); In 6 patients the platelet count was normal in the 6th month after splenectomy, the success rate was 6/7, the rate of remission was 1/6. The platelet count after splenectomy was significantly higher than that before splenectomy.ConclusionThere are no correlation between the course of disease before splenectomy and the results of splenectomy. Splenectomy is safe and effective in the treatment of idiopathic thrombocytopenic purpura.

肝素诱导的血小板减少症一例的诊治体会

肝素诱导的血小板减少症（heparin-induced thrombocytopenia，HIT）是一种罕见疾病，以血小板减少和血栓形成为主要特征。HIT可分为Ⅰ型和Ⅱ型。Ⅰ型HIT较常见，不是免疫性反应，很可能与肝素直接激活血小板有关，是一种良性反应。血小板计数多大于100×109/L，极少显著降低，且可自行恢复。Ⅱ型HIT则是免疫介导的综合征，与很多因素有关，各种给药方式都可引发，如静脉或皮下注射，甚至接触极少量肝素等。本文报告1例行冠脉介入手术使用肝素后发生血小板减少，肺泡出血及深静脉血栓形成，改为磺达肝癸钠抗凝后病情好转出院患者的诊治经过，并结合相关文献进行讨论，以提高对这一罕见疾病的认识及处理能力。临床资料 患者男性，61岁。因“持续胸骨后压榨样疼痛8 h”于2010年2月28日入院。患者于入院前8 h无明显诱因下出现持续性胸骨后压榨性疼痛，无心悸、呼吸困难、咳嗽、咯血，无头晕、意识丧失，休息后无法缓解。患者至我院急诊就诊，行心电图检查示急性前壁非ST段抬高性心肌梗死。立即急诊行冠脉造影+内支架植入术，在前降支近段，回旋支，前降支第一对角支处分别植入3枚Firebird球囊支架，术中应用普通肝素8500 U抗凝。患者术中血压、心率稳定，未诉不适。术后给予低分子肝素钙0.4 mL皮下注射1次/12 h抗凝，术后以“冠心病，急性心肌梗死”收入我院心血管内科。既往有高血压病史10余年，最高血压为200/110 mm Hg（1 mm Hg=0.133 kPa），不规律服药，血压控制不佳。无吸烟，饮酒史。入院体检：体温37.3 ℃，脉搏112次/min，呼吸23次/min，血压155/83 mm Hg。神志清，精神萎靡，心率112次/min，律齐，各瓣膜区未闻及明显杂音，两肺叩诊音略浊，右下肺可闻及少许散在湿啰音，各瓣膜区未及病理性杂音。腹部、脊柱、四肢检查无明显异常发现。

Anticoagulation Management in Patients with Heparin-induced Thrombocytopenia Undergoing Extracorporeal　Circulation

Patients with heparin-induced thrombocytopenia have a poor prognosis and high mortality, thus surgical risk under extracorporeal circulation increased. Early diagnosis, safe and effective alternative anticoagulation strategy are crucial for these patients to receive extracorporeal circulation surgery. This review focuses on the pathophysiology, laboratory examination, diagnosis and alternative anticoagulation strategy of extracorporeal circulation for patients with heparin-induced thrombocytopenia.

血小板减少症患者的心瓣膜置换术

目的总结合并血小板减少症的患者接受心瓣膜置换术的治疗经验,并探讨其可行性。方法对28例心脏瓣膜病合并血小板减少症患者施行心瓣膜置换术,入院时血小板为23×109/L～50×109/L(42.00×109/L±7.41×109/L),所有患者均使用膜肺并在预充液中分别加入300×104U～500×104U的抑肽酶。行二尖瓣置换术12例,主动脉瓣置换术8例,双瓣膜置换术8例;转流结束以鱼精蛋白中和肝素后立即输注新鲜血小板13～27U(17.8±3.9U)。结果3例术后12h内因胸腔引流管引流量大而行二次开胸探查,1例术后3d死于心室颤动,其余患者均治愈出院。结论加强术中处理,可以使血小板数维持于20×109/L～50×109/L的心脏瓣膜病合并血小板减少症的患者安全接受心瓣膜置换术。

特发性血小板减少性紫癜以眼科症状为首诊一例

乙二胺四乙酸依赖的假性血小板减少症一例

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。

婴儿特发性血小板减少性紫癜的临床分析

目的　分析婴儿期特发性血小板减少性紫癜（ITP）的诱因、临床特点、实验室资料、治疗反应和转归，为临床治疗和预后评估提供依据。 方法　2007年1月－2008年6月共收治32例ITP住院婴儿，男20例，女12例，中位年龄5个月，对其临床特征、治疗、转归进行回顾性分析。 结果　32例中14例有前驱感染，5例发病前2周～3个月内有过疫苗预防接种史。病程＜3 d者25例，3～7 d者5例，＞7 d者2例。主要表现为不同程度的皮肤、黏膜出血（包括消化道出血）。治疗以地塞米松单独或联合静脉用人血丙种球蛋白冲击，并以适量泼尼松短期维持。出血停止并且血小板计数恢复正常＜3 d者16例，3～7 d者14例，＞7 d者2例。经地塞米松冲击治疗的21例中，3例停药后又复发，再次给予联合冲击治疗，均在1周内恢复。中位随访时间12个月，无1例转为慢性或难治性病例。 结论　婴儿ITP是一组预后良好的疾病，地塞米松单独或联合静脉用人血丙种球蛋白冲击是有效治疗。免疫接种引起的ITP预后亦佳。