重组人白介素-11及重组人血小板生成素在治疗肝硬化脾功能亢进所致血小板减少的疗效对比  

Comparison of efficacy of recombinant human interleukin-11 and recombinant human thrombopoietin in treating thrombocytopenia with hypersplenism in cirrhotic patients

作　　者：刘保文[1] 向慧玲[2] 梁静[2] 韩涛[2] 

机构地区：[1]天津医科大学第三中心临床学院消化内科,天津市300170 [2]天津市第三中心医院消化内科,天津市300170

出　　处：《世界华人消化杂志》2016年第34期4608-4614,共7页World Chinese Journal of Digestology

摘　　要：目的探讨重组人白介素-11（recombinant human interleukin-11,rhIL-11）及重组人血小板生成素（recombinant human thrombopoietin,rhTPO）在治疗肝硬化脾功能亢进所致血小板减少的临床疗效及差异.方法选取肝硬化脾功能亢进所致血小板减少（PLT≤75×10^9/L）的患者66例分为两组,一组接受皮下注射rhIL-11 3 mg/次,qd;另一组接受皮下注射rhTPO 15000μg/次,qd;观察及比较两组治疗效果.结果rhIL-11和rhTPO两个治疗组入组例数分别为42例和24例,rhIL-11和rhTPO治疗后血小板数值均较治疗前增高（P〈0.05）,rhIL-11和rhTPO两组平均升高幅度分别为5.95×10^9/L±12.31×10^9/L、45.92×10^9/L±37.47×10^9/L;rhIL-11治疗的第10天血小板较治疗前明显改善（P〈0.05）,而rhTPO治疗的第7天血小板数值就较治疗前明显升高（P〈0.05）;两组均在治疗开始的第3天血小板计数开始升高,在第10天达到最大值,rhIL-11组第3、5、7、10天的血小板相比治疗前分别增长了4%、18%、21%、50%,相比治疗前,rhTPO组第3、5、7、10天的血小板分别增长了39%、84%、145%、267%;对于重度血小板减少患者,rhIL-11治疗前后血小板差异无统计学意义;在重度血小板减少患者中,rhTPO治疗后血小板数值较治疗前升高,差异具有统计学意义（P〈0.05）;rhI L-11与rhTPO治疗肝硬化血小板减少症的有效率分别为75%和100%,且二者之间有效率差异具有统计学意义（P〈0.05）;rhIL-11治疗后血红蛋白低于治疗前（P〈0.05）,治疗前后rhTPO对血红蛋白无影响;rhIL-11和rhTPO对治疗前后的白细胞、肝功能及凝血无影响;rhTPO不良反应发生率低于rhIL-11（P〈0.05）.结论rhIL-11与rhTPO均能短期显著升高肝硬化脾功能亢进患者血小板水平,相比rhIL-11,rhTPO提升血小板时间更快,对于重度血小板减少疗效更好,不良反应发生率更低.AIM To compare the efficacy of recombinant human interleukin-11（rhIL-11） and recombinant human thrombopoietin（rhTPO） in the treatment of thrombocytopenia with hypersplenism in patients with cirrhosis.METHODS Sixty-six cirrhotic patients with thrombocytopenia and hypersplenism were divided into two groups to receive either subcutaneous injection of rhIL-11 3 mg/d,once per day（n = 42） or subcutaneous injection of rhTPO 15000 μg/d,once per day（n- 24）.Therapeutic efficacy was compared between the two groups.RESULTS After treatment,mean platelet counts in both groups were significantly higher than those before treatment（P〈0.05）,and the increase ranges in the rhIL-11 group and rhTPO group were 5.95×10^9/L ± 12.31×10^9/L and 45.92×10^9/L ± 37.47×10^9/L,respectively.Mean platelet count rose significantly from the 10thday in the rhIL-11 group（P〈0.05）,but the rhTPO group had a significant increase from the 7th day（P〈0.05）.In both groups,platelet count escalated on the 3rd day and reached the maximum on 10th day.Compared with the value before treatment,platelet count increased by 4%,18%,21%,and 50%on the3rd,5th,7th,and 10th day,respectively,after rhIl-11 treatment;the corresponding values in the rhTPO group were 39%,84%,145%and 267%.For severe thrombocytopenia,there was no statistical difference in platelet count between pre- and post-rhIl-11 therapy,but mean platelet count was 75.25×10^9/L ±25.31×10^9/L after rhTPO treatment,which was significantly higher than the value before treatment（P〈0.05）.The effective rates of rhIL-11 and rhTPO therapies were 75%and100%,respectively（P〈0.05）.After rhIL-11 therapy,mean hemoglobin was signficantly less than the value before treatment（P〈0.05）,although rhTPO treatment had no significant influence on hemoglobin.Both rhIL-11 and rhTPO therapies had no influence on WBC count,liver function or coagulation function.The incidence of adverse reactions in the rhTPO group was lower than that of the rhIL-11 group.CONCLUSION Both rhIL-11

关 键 词：肝硬化 血小板减少症 重组人白介素-11 重组人血小板生成素 

分 类 号：R575.2[医药卫生—消化系统] R551.1[医药卫生—内科学] R558.2[医药卫生—临床医学]