环孢素A对难治性免疫性血小板减少性紫癜的辅助治疗  

Clinical efficacy of cyclosporine A in treatment of refractory immune thrombocytopenic purpura

作　　者：罗信国[1] 施方静 高新芳[1] 

机构地区：[1]金华市人民医院血液科,浙江金华321000

出　　处：《中国微生态学杂志》2017年第10期1179-1182,共4页Chinese Journal of Microecology

摘　　要：目的探讨环孢素A辅助治疗难治性免疫性血小板减少性紫癜(ITP)的临床疗效及对患者血小板计数和细胞因子的影响。方法选择2013年1月至2016年12月期间浙江省金华市人民医院收治的难治性ITP患者78例。按照随机数字表分为观察组39例与对照组39例。对照组患者给予利妥昔单抗治疗,观察组在对照组基础上结合环孢素A辅助治疗,两组患者疗程均为3个月。比较两组患者的疗效,治疗前后血小板计数变化,血小板恢复正常时间,治疗前后细胞因子变化及不良反应发生情况。结果观察组患者治疗总有效率(92.31%)高于对照组(69.23%),差异有统计学意义(χ2=6.6857,P<0.05);两组患者治疗后血小板计数增加,观察组患者治疗后血小板计数高于对照组、血小板恢复正常时间低于对照组,差异均有统计学意义(t=20.6717、8.1189,P<0.05);两组患者治疗后IFN-γ水平较治疗前降低,IL-4、IL-10水平升高,差异有统计学意义(观察组:t=22.9522、11.7500、11.9032,对照组:t=9.8537、7.2250、6.7012,P<0.05),且治疗后观察组患者IFN-γ水平低于对照组,IL-4、IL-10水平高于对照组,差异有统计学意义(t=13.0096、3.8277、4.7989,P<0.05);两组患者不良反应发生率比较差异无统计学意义(χ2=0.0000,P>0.05)。结论环孢素A辅助治疗难治性ITP患者疗效显著,且可增加患者血小板数量,降低IFN-γ水平,增加IL-4、IL-10水平,提高患者免疫力。Objective To investigate the clinical efficacy of cyclosporine A on refractory immune thrombocytopenic purpura（ITP）and its influence on platelet count and cytokines.Methods 78 patients with refractory ITP admitted in our hospital from January 2013 to December 2016 were selected,and randomly divided into observation group（39 cases）or control group（39 cases）.The control group was given rituximab alone,while the observation group was treated with rituximab and cyclosporine A as adjuvant therapy.Both groups were treated for a period of 3 months.The efficacy in the two groups,changes of platelet count before and after treatment,time to platelet recovery,cytokine changes before and after treatment,and incidence of adverse reactions were compared.Results The total efficiency rate in the observation group was higher than in the control group（92.31% vs 69.23%,χ2=6.6857,P0.05）.The platelet count increased after treatment in both groups.After treatment,the platelet count was higher,while the time to platelet recovery was shorter in the observation group than in the control group（t=20.6717,8.1189,P0.05）.IFN-γdecreased while IL-4 and IL-10 increased in both groups after treatment（observation group：t=22.9522,11.7500,11.9032 vs control group：t=9.8537,7.2250,6.7012,P0.05）,with the changes in observation group more significantly than in control group（t=13.0096,3.8277,4.7989,P0.05）.There was no significant difference in the incidence of adverse reactions between two groups（χ2=0.0000,P0.05）.Conclusion Cyclosporin A as an adjuvant therapy has significant efficacy in the treatment of refractory ITP,which can increase the platelet count and levels of IL-4 and IL-10 while decrease the level of IFN-γlevel,and improve the immune function of patients.

关 键 词：环孢素A 难治性免疫性血小板减少紫癜 疗效 血小板计数 细胞因子 

分 类 号：R552[医药卫生—血液循环系统疾病]