老年原发免疫性血小板减少症诊治进展
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摘要
<正>原发免疫性血小板减少症(primary immune thrombocytopenia,ITP)是一种因体液免疫和细胞免疫异常的自身免疫性疾病,主要临床表现为皮肤、黏膜、内脏等出血,同时伴有疲劳、焦虑、抑郁等症状。老年ITP是指发病年龄>60岁的ITP患者。儿童ITP患者往往起病较为迅疾,但是好转快,且有自愈倾向;而老年ITP患者除具有成年ITP患者多发展为慢性疾病的特点,同时还有合并症较多、多合并用药和疗效较差的特点。
Primary immune thrombocytopenia(ITP)is an autoimmune hemorrhagic disease caused by failure of immune tolerance.The incidence of this disease in adults is 5 to 10/10 million and tends to increase with age.With the development of aging society and increasing life expectancy,the diagnosis and treatment of elderly ITP patients will become a problem that cannot be ignored by clinicians.At present,the diagnosis of elderly ITP is mainly based on exclusive diagnosis,especially excluding malignant hematological diseases and connective tissue diseases such as myelodysplastic syndrome.In treatment,elderly patients with ITP often get poor effect than nonelderly patients,and long-term use of drugs in elderly patients with ITP will have more obvious adverse events,making the clinical use of some drugs limited.Based on the characteristics of difficulty in diagnosis and therapy of elderly ITP,this paper intends to explore the diagnosis and treatment of elderly ITP,in order to provide theoretical basis for clinical treatment.
Primary immune thrombocytopenia(ITP)is an autoimmune hemorrhagic disease caused by failure of immune tolerance.The incidence of this disease in adults is 5 to 10/10 million and tends to increase with age.With the development of aging society and increasing life expectancy,the diagnosis and treatment of elderly ITP patients will become a problem that cannot be ignored by clinicians.At present,the diagnosis of elderly ITP is mainly based on exclusive diagnosis,especially excluding malignant hematological diseases and connective tissue diseases such as myelodysplastic syndrome.In treatment,elderly patients with ITP often get poor effect than nonelderly patients,and long-term use of drugs in elderly patients with ITP will have more obvious adverse events,making the clinical use of some drugs limited.Based on the characteristics of difficulty in diagnosis and therapy of elderly ITP,this paper intends to explore the diagnosis and treatment of elderly ITP,in order to provide theoretical basis for clinical treatment.
引文
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[14]Donga PZ,Bilir SP,Little G,et al.Comparative treatment-related adverse event cost burden in immune thrombocytopenic purpura[J].Med Econ,2017,20:1200-1206.
[15]Eser A,Toptas T,Kara O,et al.Efficacy and safety of eltrombopag in treatment-refractory primary immune thrombocytopenia:a retrospective study[J].Blood Coagul Fibrinolysis,2016,27:47-52.
[16]Mazza P,Minoia C,Melpignano A,et al.The use of thrombopoietin-receptor agonists(TPO-RAs)in immune thrombocytopenia(ITP):a"real life"retrospective multicenter experience of the Rete Ematologica Pugliese(REP)[J].Ann Hematol,2016,95:239-244.
[17]Zeller MP,Heddle NM,Kelton JG,et al.Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia[J].Transfusion,2016,56:73-79.
[18]Michel M,Wasser J,Godeau B,et al.Efficacy and safety of the thrombopoietin receptor agonist romiplostim in patients aged≥65 years with immune thrombocytopenia[J].Ann Hematol,2015,94:1973-1980.
[19]Rizvi H,Butler T,Calaminici M,et al.United Kingdom immune thrombocytopenia registry:retrospective evaluation of bone marrow fibrosis in adult patients with primary immune thrombocytopenia and correlation with clinical findings[J].Br J Haematol,2015,169:590-594.
[20]Gonzalez-Porras JR,Escalante F,Pardal E,et al.Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia[J].Eur JHaematol,2013,91:236-241.
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[22]Xu T,Li N,Jin F,et al.Predictive factors of idiopathic thrombocytopenic purpura and long-term survival in Chinese adults undergoing laparoscopic splenectomy[J].Surg Laparosc Endosc Percutan Tech,2016,26:397-400.
[23]Giudice V,Rosamilio R,Serio B,et al.Role of laparoscopic splenectomy in elderly immune thrombocytopenia[J].Open Med(Wars),2016,11:361-368.
[24]Palau J,Sancho E,Herrera M,et al.Characteristics and management of primaryand other immune thrombocytopenias:Spanish registry study[J].Hematology,2017,22:484-492.
[25]张琳,王琳,石艳原,等.原发免疫性血小板减少症合并血栓形成的危险因素分析[J].临床血液学杂志,2017,30(9):693-700.
[26]Donato AJ,Morgan RG,Walker AE,et al.Cellular and molecular biology of aging endothelial cells[J].J Mol Cell Cardiol,2015,89:122-135.
[2]Mahabir VK,Ross C,Popovic S,et al.A blinded study of bone marrow examinations in patients with primary immune thrombocytopenia[J].Eur J Haematol,2012,90:121-126.
[3]Hu MH,Yu YB,Huang YC,et al.Absolute lymphocyte count and risk of short-term infection in patients with immune thrombocytopenia[J].Ann Hematol,2014,93:1023-1029.
[4]Frederiksen H,Maegbaek ML,Nrgaard M.Twentyyear mortality of adult patients with primary immune thrombocytopenia:a Danish population-based cohort study[J].Br J Haematol,2014,166:260-267.
[5]Wei Y,Ji XB,Wang YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:aprospective multicenter randomized trial[J].Blood,2016,127:296-302.
[6]Moulis G,Palmaro A,Sailler L,et al.Corticosteroid risk function of severe infection in primary immune thrombocytopenia adults.A Nationwide Nested CaseControl Study[J].PLoS One,2015,10:e0142217.
[7]Zhou H,Fu R,Wang H,et al.Immune thrombocytopenia in the elderly:clinical course in 525patients from a single center in China[J].Ann Hematol,2013,92:79-87.
[8]Mahévas M,Michel M,Godeau B.How we manage immune thrombocytopenia in the elderly[J].Haematol,2016,73:844-856.
[9]Liu W,Gu X,Fu R,et al.The effect of danazol in primary immune thrombocytopenia:an analysis of a large cohort from a single center in China[J].Clin Appl Thromb Hemost,2016,22:727-733.
[10]Daou S,Federici L,Zimmer J,et al.Idiopathic thrombocytopenic purpura in elderly patients:a study of 47cases from a single reference center[J].Eur J Intern Med,2008,19:447-451.
[11]Khellaf M,Charles-Nelson A,Fain O,et al.Safety and efficacy of rituximab in adult immune thrombocytopenia:results from a prospective registry including 248patients[J].Blood,2014,124:3228-3236.
[12]Patel VL,Mahevas M,Lee SY,et al.Outcomes 5years after response to rituximab therapy in children and adults with immune thrombocytopenia[J].Blood,2012,119:5989-5995.
[13]Choi PY,Roncolato F,Badoux X,et al.A novel triple therapy for ITP using high-dose dexamethasone,lowdose rituximab,and cyclosporine(TT4)[J].Blood,2015,126:500-503.
[14]Donga PZ,Bilir SP,Little G,et al.Comparative treatment-related adverse event cost burden in immune thrombocytopenic purpura[J].Med Econ,2017,20:1200-1206.
[15]Eser A,Toptas T,Kara O,et al.Efficacy and safety of eltrombopag in treatment-refractory primary immune thrombocytopenia:a retrospective study[J].Blood Coagul Fibrinolysis,2016,27:47-52.
[16]Mazza P,Minoia C,Melpignano A,et al.The use of thrombopoietin-receptor agonists(TPO-RAs)in immune thrombocytopenia(ITP):a"real life"retrospective multicenter experience of the Rete Ematologica Pugliese(REP)[J].Ann Hematol,2016,95:239-244.
[17]Zeller MP,Heddle NM,Kelton JG,et al.Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia[J].Transfusion,2016,56:73-79.
[18]Michel M,Wasser J,Godeau B,et al.Efficacy and safety of the thrombopoietin receptor agonist romiplostim in patients aged≥65 years with immune thrombocytopenia[J].Ann Hematol,2015,94:1973-1980.
[19]Rizvi H,Butler T,Calaminici M,et al.United Kingdom immune thrombocytopenia registry:retrospective evaluation of bone marrow fibrosis in adult patients with primary immune thrombocytopenia and correlation with clinical findings[J].Br J Haematol,2015,169:590-594.
[20]Gonzalez-Porras JR,Escalante F,Pardal E,et al.Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia[J].Eur JHaematol,2013,91:236-241.
[21]Thai LH,Mahévas M,Roudot-Thoraval F,et al.Longterm complications of splenectomy in adult immune thrombocytopenia[J].Medicine(Baltimore),2016,95:e5098.
[22]Xu T,Li N,Jin F,et al.Predictive factors of idiopathic thrombocytopenic purpura and long-term survival in Chinese adults undergoing laparoscopic splenectomy[J].Surg Laparosc Endosc Percutan Tech,2016,26:397-400.
[23]Giudice V,Rosamilio R,Serio B,et al.Role of laparoscopic splenectomy in elderly immune thrombocytopenia[J].Open Med(Wars),2016,11:361-368.
[24]Palau J,Sancho E,Herrera M,et al.Characteristics and management of primaryand other immune thrombocytopenias:Spanish registry study[J].Hematology,2017,22:484-492.
[25]张琳,王琳,石艳原,等.原发免疫性血小板减少症合并血栓形成的危险因素分析[J].临床血液学杂志,2017,30(9):693-700.
[26]Donato AJ,Morgan RG,Walker AE,et al.Cellular and molecular biology of aging endothelial cells[J].J Mol Cell Cardiol,2015,89:122-135.
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