目的 比較甲基強的松龍和地塞米松沖擊治療小兒急性原發(fā)免疫性血小板減少性紫癜的臨床療效及不良反應(yīng)。方法 回顧性分析78例急性原發(fā)免疫性血小板減少性紫癜患兒，按給予沖擊治療的糖皮質(zhì)激素不同分為甲基強的松龍沖擊治療組（n=44）和地塞米松沖擊治療組（n=34），兩組患兒分別給予甲基強的松龍20～30 mg/(kg·d)，地塞米松1.5～2 mg/(kg·d)，均靜滴3 d，第4天起減半，第7天改為口服阿賽松1.6 mg/(kg·d)序貫治療。檢測兩組患兒血小板數(shù)目、計算達到完全有效或者有效的平均反應(yīng)時間、自治療開始至活動性出血停止的平均時間，觀察治療過程中兩組患者不良反應(yīng)發(fā)生情況。結(jié)果 患兒治療有效率、治療后活動性出血停止時間兩組差異均無統(tǒng)計學意義（P＞0.05）。兩組均未見嚴重不良反應(yīng)，不良反應(yīng)發(fā)生率差異無統(tǒng)計學意義（P＞0.05）。結(jié)論 兩種糖皮質(zhì)激素沖擊治療小兒急性原發(fā)免疫性血小板減少性紫癜均能收到較好療效，短期不良反應(yīng)輕微。

Objective To compare the clinical effect and adverse reactions of shock treatment with methylprednisolone and dexamethasone in children with acute primary idiopathic thrombocytopenic purpura (ITP). Methods We retrospectively reviewed a cohort of 78 children with acute primary ITP. The patients were divided into two groups, methylprednisolone group (n=44) and dexamethasone group (n=34). Patients in methylprednisolone group were given 20 — 30 mg/(kg·d) methylprednisolone for 3 d, and patients in dexamethasone group were given 1.5 — 2 mg/(kg·d) dexamethasone for 3 d. The amounts of drugs in two groups were reduced from the day 4. On the day 7, patients were po received Asaison 1.6 mg/(kg·d) to carry out sequential therapy. We observed the platelet counts and the responses to treatments in two groups, respectively. The platelet numbers of the two groups were detected and the average reaction time was calculated since the beginning of therapy to be completely effective or effective and bleeding stopped time. At the same time, the adverse reactions of the patients were observed during the treatment. Results There was no significant difference in the treatment efficiency and bleeding stopped time between two groups (P＞0.05). No patients experienced severe adverse reaction. There was no significant difference in the adverse reactions between two groups (P＞0.05). Conclusion Two kinds of glucocorticoid are equally effective in curing acute primary ITP, and the short-term adverse reactions are mild.