만성 혈소판 감소성 자반증 환자에서 고용량 정주용 면역글로블린 및 경구용 프레드니손 투여 반응 여부와 비장 적출 효과의 예측성

Abstract

Purpose : The aim of this study is to investigate the usefulness of responsiveness to high dose intravenous immune globulin G (IVIG) or oral prednisone therapy as preoperative predictors for splenectomy response in patients with chronic idiopathic thrombocytopenic purpura (ITP). Methods : We reviewed retrospectively the charts of 23 patients who admitted to Yonsei Medical Center, Wonju Christian Hospital, Ajou Medical College Hospital and Pochon CHA General Hospital under the diagnosis of chronic ITP and splenectomized from January 1990 to April 1999, below the age of 20. All of the patients had been treated with high dose IVIG and, or oral prednisone. The responses to the treatments were classified according to Berchtold and McMillan's criteria (1) complete response (CR) > 120×103/L: (2) partial response (PR) > 50×103/L: (3) no response (NR) < 50×103/L. Results : Of 23 patients, 12 boys and 11 girls, the mean age at operation was 12.4 years (5.4∼19.4 years), the mean duration from diagnosis to splenectomy was 47 months with (6∼173 months) and mean follow up was 33 months (3∼95 months). Of the 6 patients with responses to oral prednisone, 5 had responses to splenectomy and of the 12 patients with reponses to IVIG, 10 had responses to splenectomy at 3 months. All of 14 patients with no response to oral prednisone and 4 patients with no response to IVIC were responsed to splenectomy at 3 months. Four patients relapsed during follow up and there was no serious complication following splenectomy. Conclusion : We concluded that a positive response to oral prednisone or IVIG may be associated with a positive response to subsequent splenectomy and splenectomy is an effective and safe treatment.