不同剂量丙种球蛋白与rhTPO治疗难治性血小板减少性紫癜的免疫学及氧化应激反应比较  

Comparison of immunological indexes and oxidative stress response in different doses of gamma globulin and rhTPO in treatment of refractory thrombocytopenic purpura

作　　者：杨金乐 王庆海 徐瑾[1] 杨娟[1] 彭家龙 明华丽 YANG Jinle;WANG Qinghai;XU Jin(Department of Hematologic Diseases,The Second People’s Hospital of Yichang City,Hubei,Yicang 443000,China)

机构地区：[1]湖北省宜昌市第二人民医院(三峡大学第二人民医院)血液内科

出　　处：《河北医药》2019年第16期2469-2472,共4页Hebei Medical Journal

摘　　要：目的探讨不同剂量丙种球蛋白与重组人血小板生成素(rhTPO)治疗难治性血小板减少性紫癜的免疫学及氧化应激反应。方法选取2014年8月至2017年6月接受治疗的160例难治性血小板减少性紫癜患者,根据采取的治疗方案不同分为大剂量组与小剂量组,小剂量组患者(n=75)给予小剂量丙种球蛋白联合rhTPO治疗,大剂量组患者(n=85)给予大剂量丙种球蛋白联合rhTPO治疗。比较2组患者的临床疗效、免疫功能指标、非酶抗氧化指标、酶抗氧化指标变化及不良反应发生情况。结果2组患者的血小板上升时间、血小板恢复正常时间、出血停止时间及住院时间相比差异无统计学意义(P>0.05);大剂量组治疗总有效率(90.6%)与小剂量组的治疗总有效率(85.3%)比较,差异无统计学意义(P>0.05);治疗后,2组患者的CTLA-4、IL-10、TGF-β1的水平均较治疗前明显改善(P<0.05),但2组间比较差异无统计学意义(P>0.05);治疗后,2组患者的TAC、SOD、MT、GSH的水平均较治疗前明显改善(P<0.05),但2组间比较差异无统计学意义(P>0.05);2组患者发生皮疹、头晕、恶心、嗜睡等不良反应的发生情况差异无统计学意义(P>0.05)。结论丙种球蛋白与rhTPO联合治疗难治性血小板减少性紫癜,安全有效,可明显改善患者的免疫功能及氧化应激状态,且应用小剂量与大剂量丙种球蛋白的治疗效果接近,因此选择小剂量丙种球蛋白与rhTPO联合的治疗方案具有更低的治疗成本,性价比较高。Objective To investigate the immunological indexes and oxidative stress response in different doses of gamma globulin and recombinant human thrombopoietin(rhTPO)in treatment of refractory thrombocytopenic purpura.Methods A total of 160 patients with refractory thrombocytopenic purpura who were treated in our hospital from August 2014 to June 2017 were enrolled as research subjects,who were divided into high-dose group and(n=85)low-dose group(n=75)according to different treatment schemes.The patients in low-dose group were treated by low-dose gamma globulin plus rhTPO,however,the patients in high-dose group were treated by high-dose gamma globulin plus rhTPO.The clinical curative effects,immune function indexes,non-enzymatic antioxidant indexes,enzyme antioxidant indexes and adverse reactions were observed and compared between the two groups.Results There were no significant differences in platelet increase time,platelet recovery time,bleeding stopping time and hospitalization time between the two groups(P>0.05).There was no significant difference in the total effective rate between the two groups(90.6%vs 85.3%,P>0.05).After treatment,the levels of CTLA-4,IL-10 and TGF-β1 were significantly improved in both groups,as compared with those before treatment(P<0.05),but there were no significant differences between the two groups(P>0.05).After treatment,the levels of TAC,SOD,MT and GSH in both groups were significantly improved,as compared with those before treatment(P<0.05),but there were no significant differences between the two groups(P>0.05).Moreover there was no significant difference in the incidence rate of adverse reactions including rash,dizziness,nausea and lethargy between the two groups(P>0.05).Conclusion The combination of gamma globulin with rhTPO in treatment of refractory thrombocytopenic purpura is safe and effective,which can significantly improve the immune function and oxidative stress status of patients.And the therapeutic effects of low-dose gamma globulin and high-dose gamma globulin are simila

关 键 词：难治性血小板减少性紫癜 丙种球蛋白 剂量 免疫 氧化应激 

分 类 号：R554.6[医药卫生—血液循环系统疾病]