免疫性血小板减少症合并急性冠脉综合征患者的研究进展

Research Progress on Patients with Immune Thrombocytopenia Complicated with Acute Coronary Syndrome

摘要: 免疫性血小板减少症(ITP)是一种以血小板破坏增加和生成受损为特征的自身免疫性出血性疾病，临床主要表现为不同程度的出血。当ITP患者并发急性冠脉综合征(ACS)时，临床上面临“血栓高风险”与“出血高风险”并存的治疗矛盾。目前，该类患者的临床管理仍具挑战，核心在于平衡抗血小板治疗带来的缺血获益与出血风险，然而相关高质量循证医学证据仍较为缺乏。本文围绕ITP患者血栓形成的危险因素、ITP合并ACS时的治疗策略及预后评估进行综述，以期为该类患者的个体化临床管理与预后改善提供参考。

Abstract: Immune thrombocytopenia (ITP) is an autoimmune hemorrhagic disease characterized by increased platelet destruction and impaired platelet production, with clinical manifestations mainly presenting as bleeding of varying degrees. When ITP patients are complicated with acute coronary syndrome (ACS), the clinical treatment is confronted with the contradiction of coexisting “high thrombotic risk” and “high bleeding risk”. Currently, the clinical management of such patients remains challenging, with the core issue being the balance between the ischemic benefit and bleeding risk brought by antiplatelet therapy. However, high-quality evidence-based medical evidence in this regard is still relatively scarce. This article reviews the risk factors for thrombosis in ITP patients, treatment strategies for ITP complicated with ACS, and prognosis assessment, with the aim of providing references for individualized clinical management and prognosis improvement of such patients.