重组人血小板生成素与静注人免疫球蛋白治疗成人原发免疫性血小板减少症的临床观察  

A Clinical Analysis of Treatment with Recombinant Human Thrombopoietin and Human Immunoglobulin In Adult Primary Immune Thrombocytopenia

作　　者：赵兰 张飞飞 屈蓓蓓 高青梅 韩秀华 ZHAO Lan;ZHANG Fei-fei;QV Bei-bei;GAO Qing-mei;HAN Xiu-hua(Department of Hematology,Jiading District Central Hospital Affiliated Shanghai University of Medicine ＆ Health Sciences,Shanghai,201800,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院血液科,上海201800

出　　处：《血栓与止血学》2018年第4期541-544,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的观察重组人血小板生成素(rh-TPO)联合肾上腺糖皮质激素与静注人免疫球蛋白联合肾上腺糖皮质激素治疗成人原发免疫性血小板减少症(ITP)的疗效及安全性。方法选取2014年8月至2017年11月我院血液科病房收治的57例成人原发ITP患者,随机分为三组:rh-TPO+常规剂量地塞米松(DX)组,静注人免疫球蛋白(Ig)+常规剂量DX组,对照组单用常规剂量DX。对三组资料进行对比,观察其疗效及不良反应。结果观察所有病例治疗14d,三组达有效(R)、完全反应(CR)的比例,差异无统计学意义(P> 0. 05)。三组总反应率分别为16例(94. 1%),17例(89. 5%),15例(71. 4%),差异无统计学意义(P> 0. 05)。三组中位起效时间、血小板计数达50×10~9/L中位时间、血小板计数达100×10~9/L(CR)中位时间,差异无统计学意义(P> 0. 05)。继续随访至90 d,TPO+DX组和DX组,两组患者的血小板计数维持在50～100×10~9/L之间,Ig+DX组,血小板计数维持在150～200×10~9/L之间,和前两组血小板计数水平的差异有统计学意义(P <0. 05)。少数患者出现轻微不良反应。结论 rh-TPO及Ig分别联合常规剂量肾上腺糖皮质激素治疗成人原发ITP疗效相当,且安全性良好。治疗90 d时,Ig+DX组血小板计数的维持水平最高。Objective To evaluate the clinical efficacy and safety of recombinant human thrombopoietin （rh-TPO ） and human immunoglobulin （Ig） in treatment of adult primary immune thrombocytopenia（ITP）. Methods From August 2014 to November 2017,57 patients with the diagnosis of adult primary ITP in our hospital were randomly divided into three groups, rh-TP0 group, Ig group and control group, rh-TPO group was treated with rh-TP0 combined with glucocorticoid, Ig group was treated with Ig combined with glucocorticoid, and control group was treated with glucocorticoid only. Resuits At the day 14 from the beginning of treatment, there was no significant difference in the response rates and the complete response rates in rh- TPO group, Ig group and control group （ P 〉 0. 05 ）. The total response rates in rh- TP0 group,Ig group and control group were 94. 1% ,89.5% and 71.4%. There was no significant difference in them（ P 〉 0. 05 ）. There was no significant difference in the median time to response, the median time for platelets rising to 50 ×10^9/L and the median time for platelets rising to 100 ×10^9/L in rh-TP0 group ,Ig group and control group （P 〉 0. 05 ）. At the day 90 from the beginning of treatment, the platelet acount in Ig group were significantly higher than that in the others （ P 〈 0. 05 ）. Conclusion For adult ITP, rh- TPO combined with glucocorticoid has a similar outcomes with Ig combined with glucocorticoid, and it is an effective and safe treatment option. The efficacy of Ig combined with glucocorticoid lasts longer.

关 键 词：血小板生成素 免疫球蛋白 糖皮质激素 血小板减少 

分 类 号：R558.2[医药卫生—血液循环系统疾病]