患者女，12岁。3周前曾"感冒"，近日突发皮肤及牙龈出血，体温37℃，肝脾不大。血红蛋白120g/L，白细胞6×109/L，血小板20×109/L，骨髓增生活跃，巨核细胞全片50个，幼稚型30%，采用哪种治疗（）
A.DA方案化疗
B.司坦唑醇口服
C.脾切除
D.输新鲜血浆
E.糖皮质激素
参考答案：E
解析：患者3周前有上感史，近日有突发皮肤及牙龈出血，血小板减少，巨核细胞减少而幼稚型增多，故可诊断为急性特发性血小板减少性紫癜(ITP)，治疗ITP首选糖皮质激素，常用药物为泼尼松。脾切除为ITP的二线治疗。脾切除的适应证为：正规糖皮质激素治疗无效，病程迁延6个月以上；糖皮质激素维持量>30mg/d;有糖皮质激素使用禁忌证。故答案选E。
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| Vanilla is my best friend. She is a lovely girl with two big, beautiful eyes. But she always hides them 1 a pair of black glasses. One day, however, I 2 ended our friendship. I remember that day clearly. We were 3 in the classroom. The teacher was giving us our results of a Chinese exam. I had done badly. I felt so 4 that I wouldn't talk to anyone. At lunchtime, I even stayed in the classroom alone. Suddenly, I heard a 5 . It was Vanilla."You look very unhappy," she said."What's wrong?" I looked at her for a while, but said 6 . I knew Vanilla had got a good mark (分数) in the exam. I thought she was 7 me. I sat silently, but Vanilla didn't go away. She 8 asking me questions,"Is it because of the exam? Do you want me to tell you the right 9 ?" I looked away from her. When I looked up again, Vanilla had gone. And so had my exam paper! I didn't know 10 to do. I looked for my paper everywhere, but couldn't find it. In the afternoon, Vanilla came up to my desk and 11 me my exam paper back. I looked at it and got a big 12 . Vanilla had written the right answers next to every one of my mistakes. How 13 she was! My face turned red. I wanted to hug her, but I only held her hands and said,"Thank you." That afternoon, 14 Vanilla and I were on the way home, I felt quite happy and thanked her again. We are 15 best friends. | ||||
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