造血干细胞移植治疗重型再生障碍性贫血:血小板生成素促血小板植入的有效性和安全性  

Thrombopoietin improves platelet recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia: an assessment of safety and efficacy

作　　者：郭智 任骅 吉勇 陈丽萍 陈丽娜 刘玄勇 郑珊珊 刘晓东 陈惠仁 Guo Zhi;Ren Hua;Ji Yong;Chen Liping;Chen Lina;Liu Xuanyong;Zheng Shanshan;Liu Xiaodong;Chen Huiren(Department of Hematology,National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,Guangdong Province,China;Department of Hematology,The Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院血液科,广东省深圳市518116 [2]中国人民解放军总医院第七医学中心血液科,北京市100700

出　　处：《中国组织工程研究》2019年第33期5269-5274,共6页Chinese Journal of Tissue Engineering Research

基　　金：深圳市卫生系统科研项目(SZLY2018003),项目负责人:郭智;中国医学科学院肿瘤医院深圳医院2018年医疗卫生三名工程课题(2018-nk003),项目负责人:郭智~~

摘　　要：背景:研究表明,异基因造血干细胞移植后应用血小板生成素在造血调控、造血重建等方面有一定作用,为临床推广应用提供理论基础。目的:分析血小板生成素在异基因造血干细胞移植治疗重型再生障碍性贫血中促进血小板植入的临床疗效和安全性。方法:2012年1月至2017年1月共入选50例接受异基因造血干细胞移植治疗的重型再生障碍性贫血患者,分为治疗组和对照组各25例,其中男28例,女22例,平均年龄27.8(16-48)岁,治疗组在移植后7 d起应用血小板生成素300 U/kg,连续14 d,比较两组患者血小板植入后在≥20×10^9 L^-1、50×10^9 L^-1和100×10^9 L^-1的时间节点及血小板中位输注次数。该治疗方案得到解放军陆军总医院伦理委员会批准和患者知情同意。结果与结论:两组患者均获造血重建,治疗组和对照组血小板≥20×10^9 L^-1、50×10^9 L^-1和100×10^9 L^-1的中位时间分别为16.2,19.3,30.2 d和18.8,25.8,38.5 d,治疗组血小板植入时间比对照组分别提前2.6,6.5,8.3 d,辐照血小板中位输注次数分别为6.8次和9.5次,两组数据结果显示差异有显著性意义(P<0.05)。随访至2017年7月,两组患者无病生存率分别为80%,72%。结果表明,血小板生成素能够促进异基因造血干细胞移植后血小板植入及恢复,且患者耐受性好,值得临床进一步推广应用。BACKGROUND: Studies have shown that the use of thrombopoietin after allogeneic hematopoietic stem cell transplantation has a certainrole in hematopoietic regulation and hematopoietic reconstitution, providing a theoretical basis for clinical application.OBJECTIVE: To analyze the clinical efficacy and safety of thrombopietin in the treatment of severe aplastic anemia after hematopoietic stemcell transplantation.METHODS: Fifty patients receiving allogeneic hematopoietic stem cell transplantation from January 2012 to January 2017 including 28 malesand 22 females with the mean age of 27.8 (16-48) years were enrolled. Patients received 300 U/kg thrombopietin (treatment group, n=25)subcutaneously, which began at 7 days after transplantation, or were only treated with symptomatic treatment (control group, n=25). Timenode of platelet implantation in two groups of patients ≥ 20×10^9/L, 50×10^9/L, and 100×10^9/L and median Infusion times of platelet werecompared between two groups. The study protocol was approved by the Ethics Committee of Army General Hospital, and enrolled patientssigned informed consent prior to the inception of the trial.RESULTS AND CONCLUSION: The median time of platelet implantation ≥ 20×10^9/L, 50×10^9/L, and 100×10^9/L was 16.2, 19.3, and 30.2 daysin the treatment group and 18.8, 25.8, and 38.5 days in the control group, respectively. The time of platelet implantation time in the treatmentgroup was 2.6, 6.5, and 8.3 days earlier than that in the control group. The median number of irradiated platelet implantation was 6.8 times inthe treatment group and 9.5 times in the control group. There was a significant difference between the two groups (P < 0.05). All the patientswere followed up to July 2017, and the disease-free survival rates were 80% in the treatment group and 72% in the control group. Thesefindings indicate that thrombopietin can promote platelet implantation and recovery after allogeneic hematopoietic stem cell transplantation,and is well tolerated, which is worthy of further c

关 键 词：重型再生障碍性贫血 异基因造血干细胞移植 血小板生成素 血小板植入 造血调控 造血重建 

分 类 号：R457[医药卫生—治疗学] R318[医药卫生—临床医学]