糖皮质激素治疗特发性血小板减少性紫癜疗效相关因素分析

【】　目的　探讨影响糖皮质激素治疗特发性血小板减少性紫癜疗效的主要因素。　方法　回顾分析2008年1月-2010年7月173例特发性血小板减少性紫癜患者的临床资料，采用χ2检验及Logistic回归分析影响糖皮质激素疗效的相关临床因素。　结果　单因素χ2检验分析显示性别、骨髓巨核细胞计数水平、骨髓产板巨核细胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平对糖皮质激素疗效的影响有统计学意义（P<0.05）。脾脏长大、抗核抗体（ANA）阳性、补体C3水平降低与糖皮质激素疗效无关。多因素Logistic回归分析显示性别、HBsAg是影响糖皮质激素疗效的相关因素。　结论　男性、骨髓巨核细胞计数增多、产板巨比例降低者对糖皮质激素治疗反应较好。女性、血清免疫球蛋白水平异常、骨髓巨核细胞不增多者及HBsAg阳性的患者对糖皮质激素治疗反应相对较差。性别、HBsAg是影响糖皮质激素疗效的主要因素。【Abstract】　Objective　Todiscusstheinfluencingfactorsassociatedwiththeefficacyofglucocorticoidforidiopathicthrombocytopenicpurpura.　Methods　Weretrospectivelyanalyzedtheclinicaldataof173patientswithidiopathicthrombocytopenicpurpurawhoacceptedtheirfirsttreatmentinWestChinaHospitalbetweenJanuary2008andJuly2010.TheaffectingfactorsontheefficacyofthetreatmentwereanalyzedbymeansofChi-squaretestandbinarylogisticregressionanalysis.　Results　TheresultsofChi-squaretestshowedthatgender,bonemarrowmegakaryocytecount,thepercentageofplatelet-producingmegakaryocytes,HBsAg,andthelevelofserumimmunoglobulincouldhaveasignificantinfluenceontheoutcomeofglucocorticoidtreatment(P<0.05),whilesplenomegaly,positiveANAanddecreasingofthelevelofcomplementC3werenotcorrelatedwiththeoutcomeofglucocorticoidtreatment.TheresultsofmultivariatelogisticregressionanalysisshowedthatgenderandHBsAgwerecorrelatedwiththeglucocorticoidtreatmentforpatientswithidiopathicthrombocytopenicpurpura.　Conclusion　Malepatients,patientswithincreasingbonemarrowmegakaryocytesandpatientswithdecreasingpercentageofplatelet-producingmegakaryocyteshavebetterresponsestoglucocorticoid,whilefemalepatients,patientswithabnormalserumimmunoglobulinlevelandpatientswithnon-increasingnumberofbonemarrowmegakaryocyteshavepoorresponsestowardglucocorticoidtreatment.GenderandHBsAgarethemaininfluencingfactorsfortheresponsetoglucocorticoid.