4例难治性犬免疫性血小板减少症的诊治

Diagnosis and Treatment of 4 Dogs with Refractory Immune Thrombocytopenia

摘要: 免疫性血小板减少症(Immune Thrombocytopenia, ITP)是犬常见的一种自身免疫性凝血疾病，目前兽医学对ITP的诊断主要是排除法。治疗主要以糖皮质激素为主，并联合免疫抑制剂使用，常用药物包括皮质类固醇、静脉注射免疫球蛋白，静脉注射长春新碱、硫唑嘌呤、环孢素、霉酚酸酯等，在复发性病例会考虑脾切除等。但针对顽固性、难治性的ITP，上述治疗通常无法改善病情，患犬会因为血小板减少导致进行性的血液丢失，需要通过持续输注全血来维持生命，最终面临死亡。本报告旨在探讨犬ITP的新型治疗手段，尤其是类似本文4例对常规一、二线治疗无反应的难治性ITP。在本报告中，将新型的治疗药物血小板生成素受体激动剂罗米司亭，用于4例经多种糖皮质激素和不同免疫抑制剂联合给药均无改善的难治性ITP患犬，皮下注射罗米司亭后3天血小板数量开始恢复，并随时间的持续增长保持稳定，达到临床缓解，且无临床不良反应。实践证明，使用血小板生成素受体激动剂罗司亭治疗高度敏感且安全。

Abstract: Immune thrombocytopenia (ITP) is a common autoimmune coagulation disease in dogs. At present, the diagnosis of ITP is mainly exclusion method in veterinary medicine. Treatment is mainly based on glucocorticoids and combined with immunosuppressants. Commonly used drugs include corticosteroids, intravenous immunoglobulin, intravenous vincristine, azathioprine, cyclosporine, mycophenolate mofetil, etc., splenectomy will be considered in recurrent cases. However, for intractable and refractory ITP, when the above treatment is ineffective, because of the progressive blood loss caused by thrombocytopenia, the affected dog needs multiple blood infusions to maintain life, and eventually faces death. The purpose of this report is to discuss the new treatment for canine ITP, especially the 4 cases of refractory ITP that did not respond to conventional first-line and second-line treatment. In this report, Romiplostim, a new therapeutic drug thrombopoietin receptor agonist, was used in 4 dogs with refractory ITP who did not improve after the combined administration of multiple glucocorticoids and different immunosuppressants. The number of platelets began to recover 3 days after the subcutaneous injection of Romiplostim, and remained stable over time, achieving clinical remission, and no clinical adverse reactions. Practice has proved that the use of thrombopoietin receptor agonist Romiplostim is highly sensitive and safe.