스테로이드 불응성 특발성 혈소판 감소성 자반증의 임상적 고찰

Abstract

ABSTRACT

A clinical study of steroid refractory idiopathic thrombocytopenic purpura

Jang Kwang Pyo Advisor : Prof. Jung chun Hae Ph. D Department of Medicine Graduate School of Chosun University

Purpose Idiopathic thrombocytopenic purpura(ITP) is an immune disorder in which platelets are opsonized by autoantibodies, and is prematurely by the reticuloendothelial system. This disease undertakes a chronic pathway in adults and is 3 times more prevalent in women compared to men. If steroid refractory ITP were to have a specific clinical course, efficacious treatment would take place.

Patient & Method This study was done in 61 patients who were diagnosed with ITP at Chosun University hospital, Dept of internal medicine between Nov.2001 and Feb. 2008.

Result I. Chronic ITP Steroid refractory ITP included 37 patient(67%).There is no clinical significant correlation between the refractoriness to steroid and the initial platelet count(p-value:0.166), the age(0.176), sex(0.176) of adult patients at the time of diagnosis.

Ⅱ. Steroid refractory ITP Treatment for steroid refractory ITP were splenectomy, danazol, rituximab, H. pyroli eradication. In 2nd line treatment for steroid refractory ITP, response rates are 88%/43%/50%(splenectomy/H. pyroli eradication/rituximab). The median duration to response for splenectomy and H. pyroli eradication and rituximab are 3days and 2.5weeks and 3months. Eight patients underwent splenectomy. Immediately after splenectomy, complete response was obtained by seven patients(88%), but during the follow-up period, two patients(29%) relapsed after splenectomy. Splenectomy failed in one patient due to post op complication(sepsis). Four patients underwent danazol therapy. But no positive effects were seen. Of the two patients treated by rituximab, one patient showed partial response(50%). But the other patient showed no effect. Seven patients underwent H. pyroli eradication therapy. Three patients showed complete response, but four patients failed.

Conclusion Our findings suggest that splenectomy, H. pyroli eradication(If H. pyroli infected) and rituximab are a beneficial choice as the 2nd line treatment for patients with steroid refractory ITP. Key word: ITP, steroid, refractory