【摘要】 目的 探討影響糖皮質(zhì)激素治療特發(fā)性血小板減少性紫癜療效的主要因素。 方法 回顧分析2008年1月-2010年7月173例特發(fā)性血小板減少性紫癜患者的臨床資料，采用χ2檢驗及Logistic回歸分析影響糖皮質(zhì)激素療效的相關(guān)臨床因素?！〗Y(jié)果 單因素χ2檢驗分析顯示性別、骨髓巨核細胞計數(shù)水平、骨髓產(chǎn)板巨核細胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平對糖皮質(zhì)激素療效的影響有統(tǒng)計學(xué)意義（Plt;0.05）。脾臟長大、抗核抗體（ANA）陽性、補體C3水平降低與糖皮質(zhì)激素療效無關(guān)。多因素Logistic回歸分析顯示性別、HBsAg是影響糖皮質(zhì)激素療效的相關(guān)因素。 結(jié)論 男性、骨髓巨核細胞計數(shù)增多、產(chǎn)板巨比例降低者對糖皮質(zhì)激素治療反應(yīng)較好。女性、血清免疫球蛋白水平異常、骨髓巨核細胞不增多者及HBsAg陽性的患者對糖皮質(zhì)激素治療反應(yīng)相對較差。性別、HBsAg是影響糖皮質(zhì)激素療效的主要因素?！続bstract】 Objective To discuss the influencing factors associated with the efficacy of glucocorticoid for idiopathic thrombocytopenic purpura. Methods We retrospectively analyzed the clinical data of 173 patients with idiopathic thrombocytopenic purpura who accepted their first treatment in West China Hospital between January 2008 and July 2010. The affecting factors on the efficacy of the treatment were analyzed by means of Chi-square test and binary logistic regression analysis. Results The results of Chi-square test showed that gender, bone marrow megakaryocyte count, the percentage of platelet-producing megakaryocytes, HBsAg, and the level of serum immunoglobulin could have a significant influence on the outcome of glucocorticoid treatment (Plt;0.05), while splenomegaly, positive ANA and decreasing of the level of complement C3 were not correlated with the outcome of glucocorticoid treatment. The results of multivariate logistic regression analysis showed that gender and HBsAg were correlated with the glucocorticoid treatment for patients with idiopathic thrombocytopenic purpura. Conclusion Male patients, patients with increasing bone marrow megakaryocytes and patients with decreasing percentage of platelet-producing megakaryocytes have better responses to glucocorticoid, while female patients, patients with abnormal serum immunoglobulin level and patients with non-increasing number of bone marrow megakaryocytes have poor responses toward glucocorticoid treatment. Gender and HBsAg are the main influencing factors for the response to glucocorticoid.
目的 探討骨髓增生異常綜合征（MDS）患者的臨床特點。 方法 選取我院2008年3月－2012年10月確診為MDS的231例患者臨床資料進行回顧性分析。患者年齡21～87歲，中位年齡59歲。 結(jié)果 231例患者中，難治性血細胞減少伴多系發(fā)育異常（RCMD）最多見，占45.0%（104/231）；以貧血乏力癥狀就診多見占66.7%（154/231）；血常規(guī)中以全血細胞均減少多見占61%（141例/231例）；網(wǎng)織紅細胞以正常或增高為主占61%（141/231）；低熒光值增高多見62%（144/231）。乳酸脫氫酶和鐵蛋白在各診斷亞型及各國際預(yù)后積分系統(tǒng)（IPSS）評分間存在差異，其中乳酸脫氫酶在難治性貧血伴原始細胞增多2型（RAEB-2）中高于綜合組：難治性貧血（RA）、 難治性貧血伴環(huán)狀鐵粒幼細胞（RAS）、5q?綜合征及RCMD相比較差異有統(tǒng)計學(xué)意義（P＜0.05），高危組乳酸脫氫酶高于中危1組及中危2組，其差異有統(tǒng)計學(xué)意義（P＜0.05），高危組鐵蛋白高于中危1組其差異有統(tǒng)計學(xué)意義（P＜0.05），其余差異無統(tǒng)計學(xué)意義（P＞0.05）。染色體異常率為39%，其中20例為復(fù)雜染色體核型，IPSS評分中危1最多見為52.4%（55/105）。 結(jié)論 MDS臨床表現(xiàn)多樣，缺乏特異性，需綜合骨髓涂片、活檢、細胞遺傳學(xué)的結(jié)果提高診斷率。