Study On The Early Treatment Response And Influencing Factors Of Dexamethasone Sequential Prednisone Treatment For The Patients With Severe Primary Immune Thrombocytopenia

Objective:To investigate the correlation and influencing factors of early response and efficacy of sequential prednisone oral administration with short-term intravenous infusion of dexamethasone in the treatment of severe primary immune thrombocytopenia.This study provides a basis for clinicians to identify the patients with ineffective glucocorticoid treatment,timely adjust the second-line treatment,and avoid the adverse reactions caused by long-term application of glucocorticoid.Methods:We retrospectively analyzed medical records of the 81 patients with severe ITP who received dexamethasone 10mg/d×5d intravenous infusion and prednisone1mg/kg·d oral administration at the hematology department of the 967 Hospital of the Chinese people's Liberation Army from January 2016 to January 2019.The 3rd and6th day of glucocorticoid sequential treatment were the observation points of early treatment response,and the 28th day was the observation point of curative effect,and the platelet count was taken as an index to assess the early treatment response and efficacy.The subjects were divided into effective group and ineffective group according to the early treatment response on the 6th day,the related indicators were analyzed,such as clinical indicators(gender,age,clinical asthenia,with or without co-infection,bleeding score,platelet transfusion volume of single donor),blood routine including WBC,NEUT,LYMPH,MONO,RBC,Hb,PLT,bone marrow megakaryocyte counts,immune indexes including antinuclear antibody,complement C3,complement C4,Ig G,Ig M,Ig A on admission.The correlation results were used to determine the relationship with early treatment response.Result:1.After sequential treatment with glucocorticoid,the median PLT counts of 81severe ITP patients on the 3rd,6th and 28th day were significantly higher than that before treatment,which were 19.00×10~9/L,47.00×10~9/L and 79.00×10~9/L respectively.The PLT counts in the effective group more significantly increased,which were 29.50×10~9/L,73.00×10~9/L and 119.00×10~9/L respectively.And there was a significant difference between the effective group and the ineffective group(P<0.05).The effective rate on the 3rd and 6th day were 71.60%and 74.10%respectively.On the 28th day,the CR rate,R rate and NR rate were37.00%,42.00%and21.00%,respectively,and the total effective rates were 79.00%.The difference from the patients between the three groups was not statistically significant(P>0.05).According to Pearson's correlation analysis,the effective rates on the 3rd,6th and 28th days were correlated(P<0.05).2.The age,clinical asthenia,NEUT,bone marrow megakaryocyte counts,ANA,complement C3 had statistically significant on the effective group and the ineffective group(P<0.05).The indexes including gender,with or without co-infection,bleeding score,platelet transfusion volume of single donor,WBC,LYMPH,MONO,RBC,Hb,PLT,Ig G,Ig M,Ig A weren't statistically significant between two group(P>0.05).The Spearman rank correlation study showed that the megakaryocyte number in bone marrow was correlated with early therapeutic effectiveness(R=-0.462,P<0.05).Logistic regression analysis showed that bone marrow megakaryocytes number and complement C3 were the independent prognostic factors for the early treatment response from the sequential glucocorticoid treatment.Conclusion:1.The sequential glucocorticoid is an effective treatment method for tsevere ITP patients.Early application of dexamethasone can significantly increase the platelets of patients with severe ITP patients,and can greatly reduce the risk of bleeding.Then sequential application of prednisone can consolidate the therapeutic effectiveness.2.Early treatment response of the sequential glucocorticoid treatment can be an early predictor of glucocorticoid efficacy.3.The patients with more bone marrow megakaryocytes numbers before the sequential glucocorticoid treatment can obtain the better early treatment response.Positive ANA and low level of complement C3 have a negative impact on the early treatment response.The bone marrow megakaryocyte number and complement C3 are the independent related factors influencing the early treatment response to the sequential glucocorticoid treatment.