【正文】
(46 weekly doses) 714 d 742 d ? Vinblastine mg/kg per dose iv ? (6 weekly doses) 714 d 742 d ? Danazol 400800 mg po daily 1490 d 28180 d ? Azathioprine 2 mg/kg po daily 3090 d 30180 d ? AMG 310 μg/kg weekly sc 514 d 1460 d ? Eltrombopag 5075 mg po daily 728 d 1490 d 難治性 ITP定義、治療目標及 反應(yīng)評估 ? 難治性患者應(yīng)滿足 2個標準:脾切除失敗或術(shù)后復(fù)發(fā);患者表現(xiàn)為嚴重 ITP或出血危險性需要治療。 治療反應(yīng)的界定 ? Proposed criteria for assessing response to ITP treatments ? CR: platelet count ≥ 100 109/L and absence of bleeding ? R: platelet count ≥ 30 109/L and at least 2fold increase the baseline count and absence of bleeding ? Time to response: time from starting treatment to time of achievement of CR or R ? NR: platelet count 30 109/L or less than 2fold increase of baseline platelet count or bleeding ? Loss of CR or R: platelet count below 100 109/L or bleeding (from CR) or below 30 109/L or less than 2fold increase of baseline platelet count or bleeding (from R) 治療反應(yīng)的界定 ? Corticosteroiddependence ? The need for ongoing or repeated doses administration of corticosteroids for at least 2 months to maintain a platelet count at or above 30 109/L and/or to avoid bleeding (patients with corticosteroid dependence are considered nonresponders) 治療反應(yīng)的界定 ? For response criteria in refractory ITP ? HRQoL indicates healthrelated qualityoflife assessment. ? Platelet counts should be confirmed on at least 2 separate occasions (at least 7 days apart when used to define CR, R) or 1 day apart when used to define NR or loss of response. ? Baseline platelet count refers to platelet count at the time of starting of the investigated treatment。在下列臨床過程中,血小板計數(shù)的參考值分別為:口腔科檢查: ≥20 109/L;拔牙或補牙: ≥30 109/L;小手術(shù): ≥50 109/L;大手術(shù): ≥80 109/L;自然分娩: ≥50 109/L;剖腹產(chǎn): ≥80 109/L。 治療目標 下述的危險因素增加出血風(fēng)險:( 1)年齡的增加、患病時間延長,出血風(fēng)險加大;( 2)血小板功能缺陷;( 3)凝血因子缺陷;( 4)未被控制的高血壓;( 5)外科手術(shù)或外傷;( 6)感染;( 7)必須服用阿司匹林、非甾體類抗炎藥、華法林等抗凝藥物。因此,“基于要求的治療”或可預(yù)見的出血狀態(tài)或手術(shù)操作是另一種需治療的恰當方法。但是,新療法的應(yīng)用,因為早期干預(yù)增加了長期反應(yīng)的幾率。 治療目標 ? 初診患者或要求第一時間治療患者治療目的是盡快達到安全血小板數(shù)量以預(yù)防或終止出血,保證合適的生活質(zhì)量并最少治療相關(guān)毒性。多數(shù)指南建議,成人ITP血小板低于 30 109/L應(yīng)考