2016ITP共识解读.pptVIP

排除继发性血小板减少 EDTA诱导的假性血小板减少 遗传/先天性血小板减少综合症 继发性血小板减少 -- 免疫性： 药物相关性血小板减少 病毒（HIV、HCV）相关性血小板减少 继发于自免病、淋巴增殖性疾病等血小板减少 -- 非免疫性：再障、MDS、脾亢、DIC、TTP等 脾切除后感染风险增加 Rituximab Blood. 2001;98:952-957. Ann Intern Med. 2007;146:25-33. Haematologica. 2008; 93:930-3. Blood. 2012;119:5989-95. Br J Haematol. 2012;158:386-398 Blood 2014;124:3228-3236 Blood. 2015;125:1541-7. Lancet. 2015;385:1653-61. Rituximab(Standard dose) Auger, et al. Br J Haematol. 2012;158:386-398. Long-term follow-up analysis after rituximab salvage therapy Zaja, F., et al. (2012). Am J Hematol 87(9): 886-889. Long term response to rituximab Patel, V. L., et al. (2012). Blood 119(25): 5989-5995. Libor Cervinek, et al. Int J Hematol. 2012 87(9): 886-889. Estimated event-free survival curves with standard dose or low dose Ghanima W et al. Lancet. 2015 25;385(9978):1653-61. Rituximab as second-line treatment for adult immune thrombocytopenia (the RITP trial): a multicentre, randomised, double-blind, placebo-controlled trial Zhou H,et al.Blood.? 2015;125(10):1541-7. rhTPO plus rituximab RTX ? rhTPO RTX P CR, % (n) 45.4 (35) 23.7 (9) 0.026 R, % (n) 33.8 (26) 47.4 (18) 0.22 OR, % (n) 79.2 (61) 71.1 (27) 0.36 NR, % (n) 20.8 (16) 28.9 (11) 0.36 For patients with an initial response RTX ? rhTPO RTX P? TTR (days), median (range) 7 (4-28) 28 (4-90) 0.004 Duration of response (? 6 months), % (n) 67.2 (41) 55.6 (15) 0.34 Duration of response (? 12 months), % (n) 44.3 (27) 29.6 (8) 0.24 Duration of response (? 24 months), % (n) 24.6 (15) 18.5 (5) 0.59 Splenectomy 32% sustained response surgical risk post-splenectomy state Blood. 2004;104(9):2623-34. Blood. 2013;121(23):4782-90. 成人ITP的二线治疗- 3 Blood. 2013;121(23):4782-90. ITP患者脾切除率逐年下降 脾切除后静脉血栓形成风险增加 Blood. 2013;121(23):4782-90. Blood. 2013;121(23):4782-90. Azathioprine（硫唑嘌呤） Cyclosporin A（环孢素A） Danazol（达那唑） Vinca alkaloids (长春碱类) 成人ITP的二线治疗- 其他 提纲 概述 诊断要点 治疗原则与方案 疗效判断 疗效判断 完全反