| Objective: The aim of this study was to investigate the efficacy ofdifferent therapy methods and the impact on the quality of life in patients withthe Immune Thrombocytopenia(ITP).Methods: The clinical data of202hospitalized patients with ITP werecollected and retrospectively analyzed in Second Hospital of Hebei MedicalUniversity from January2010to January2013. The incidence of infection andglucocorticoids-related adverse events after treatments were mainlyfollowed-up in these patients. Among of the alive183cases, who received thefollowing first-line therapies, including81cases of single-agentglucocorticoids,6cases of intravenous human immunoglobulin (IVIG)therapy alone and93cases of glucocorticoids combined with IVIG. During thefollow-up, these183cases were divided into two groups according to whetherrelapse or not.. And according to whether the repeated application ofhormones was used in the recurrent cases, whether immunosuppressive drugswere applied, and whether the splenectomy was performed, these183caseswere divided into different refined groups. The occurrence of infections andhormonal adverse reactions(elevated blood sugar and blood pressure,changes of body shape, skin and hair, changes of bones, fatigue, edema, etc.)after therapy were used as assessment indicators of the quality of life. Theappearance of adverse reactions including infections and hormonal side effectsafter the application of first-line treatment was accepted as the assessmentindicators of the quality of life. The efficacy and the treatment-related adverseevents after treatment were compared in the following groups:1Among thedifferent types of first-line therapies group;2Between the relapse group andthe non-relapse group;3Among the different subgroups of relapse patients.Statistical comparisons among different groups were conducted using Chi-square test. All analyses were performed using GraphPad Prism Version5.0(San Diego, CA, USA) and P<0.05was considered statistically significant.Results:1After first-line treatments, there was no significant difference in theefficacy, relapse rates, infections and the glucocorticoids-related side eventsbetween the single-agent glucocorticoids group and combination therapygroup of glucocorticoids and IVIG.. In cases applied with hormone therapyalone, the effective rate was98.0%of high-dose methylprednisolone therapy,higher than high-dose dexamethasone group (66.7%) and the standard-dosemethylprednisolone group (81.5%)（P＜0.017）, but the therapy was morelikely to cause elevated blood glucose (P＜0.05). Single treatment withhigh-dose methylprednisolone is more efficient than high-dosemethylprednisolone combined IVIG therapy group (75%)(P＜0.05), and therate of blood sugar elevation between the two groups was no difference in theproportion. The efficiency of single treatment with high-dosemethylprednisolone group had no difference to the efficiency of combinedmethylprednisolone with IVIG treatment group (90.8%)（P>0.05）, butthe former group was more likely to relapse (P＜0.008).2In79non-relapse patients,31cases (39.2%) occurred the infection aftertherapy. However,58cases (55.8%) in104relapsed patients complicated theinfection after therapy. The rate of infection in relapse group is higher thanthat of non-relapse group (P＜0.05). The incidence of glucocorticoids-relatedadverse events such as prolonged hyperglycemia, changes of body shape,abnormalities of skin and hair in relapse group was significant higher thannon-relapse group(P＜0.05).3The104cases of recurrence were divided into2groups by whether arepeated long-term use of hormone therapy (≥2courses of treatment, ormore than1year) was applied.70cases used hormone repeatedly and theother group had34cases, while in the former group42people occurredinfection after treatment and the other group had16people infected. Betweenthese two groups, there was no difference (P>0.05) on the ratio of infections and adverse reactions of hormone therapy.4The relapsed cases were divided into groups by whetherimmunosuppressive drugs were applied.45cases were treated byimmunosuppressive drugs, while60cases were not. After treated byimmunosuppressive drugs there were25people infected, while the othergroup had33infected people, which were no differences (P>0.05) in theratio of the number of infections occurred after treatment.5The relapsed cases were divided into2groups by whether thesplenectomy was performed.21cases applied, of which14were infected aftersurgery,5people had lung infection.83cases didn’t have splenectomy therapy,of which44people were infected and5of them had lung infections. The rateof pulmonary infection in patients after splenectomy was higher than the othergroup (P <0.05).6The relapsed cases were divided into groups by whether steroid，immunosuppressive drugs，rituximab，splenectomy and danazol were applied.93cases were treated multiply by the drugs above of which55cases wereinfected, while11cases were not of which3cases were infected. The rate ofinfection in patients after multiple treatments was higher than the other group(P <0.05).Conclusions: The current first-line treatments could achieve goodefficiency. For these patients who received high-dose glucocorticoidscombined with IVIG therapy, high-dose glucocorticoids could neither increasethe efficacy, nor reduce the relapse rate. In combination therapy with IVIG,choosing the standard-dose glucocorticoids may be better with equivalentefficacy and reduced relapse rate. For relapsed patients, the incidence ofinfections, prolonged hyperglycemia and changes of body and skin wereobviously increased. Neither repeated-use of glucocorticoids norimmunosuppressants have obvious effect on the increased risk of infection,but relapsed patients with splenectomy can clearly increase the risk ofpulmonary infection. The relapsed patients who had been treated by a mixture of multiple treatments had a higher ratio of infection. |
PDF Full Text Request