重组人血小板生成素在老年重症免疫性血小板减少症患者一线治疗中的短期疗效分析  

Short-term efficacy of recombinant human thrombopoietin as first-line treatment in elderly patients with severe immune thrombocytopenia

作　　者：李炀 孙丽华 李锋 李莹 侯芸华 孟亚红 范小红 王雪莲 陆燕 程韵枫 化范例 LI Yang;SUN Li-hua;LI Feng;LI Ying;HOU Yun-hua;MENG Ya-hong;FAN Xiao-hong;WANG Xue-lian;LU Yan;CHENG Yun-feng;HUA Fan-li(Department of Hematology,Qingpu Branch,Zhongshan Hospital,Fudan University,Shanghai 201700,China;Department of Hematology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Hematology,Jinshan Hospital,Fudan University,Shanghai 201508,China;Department of Hematology,Minhang Hospital,Fudan University,Shanghai 201100,China;Biomedical Research Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院青浦分院血液科,上海201700 [2]复旦大学附属中山医院血液科,上海200032 [3]复旦大学附属金山医院血液科,上海201508 [4]复旦大学附属闵行医院血液科,上海201100 [5]复旦大学附属中山医院实验研究中心,上海200032

出　　处：《中国临床医学》2021年第3期370-374,共5页Chinese Journal of Clinical Medicine

基　　金：上海市自然科学基金(19ZR1410000);上海市科学技术委员会引导类项目(19411972200);上海市卫生健康委员会基金(201840352);上海市青浦区卫生健康委员会学科人才专项资助(WZ2019-01,WD2019-04)。

摘　　要：目的:探讨重组人血小板生成素(recombinant human thrombopoietin,rhTPO)在老年重症原发免疫性血小板减少症(primary immune thrombocytopenia,ITP)患者一线治疗中的短期疗效。方法:回顾性选择2016年3月至2019年11月复旦大学附属中山医院青浦分院血液科和复旦大学附属金山医院血液科收治的36例老年(≥65岁)重症初治ITP患者,分为接受rhTPO联合经典一线方案治疗组(rhTPO组,n=22)和仅接受经典一线方案治疗组(对照组,n=14)。比较2组短期有效率、起效时间、血小板峰值、血小板达峰时间等,分析影响rhTPO疗效的相关因素。结果:rhTPO组和对照组的短期总有效率分别为100%(22/22)和92.9%(13/14),短期完全反应率分别为72.7%(16/22)和64.3%(9/14),差异均无统计学意义。但rhTPO组的中位起效时间显著短于对照组[4.0(3.0,6.0)d vs 6.0(4.0,7.3)d,P=0.026]。在未接受静脉输注免疫球蛋白和血小板输注的患者中,rhTPO组血小板峰值显著高于对照组[(126.8±42.9)×109/L vs(79.3±42.0)×109/L,P=0.031]。结论:rhTPO一线治疗可有效缩短老年重症ITP患者的起效时间,提高血小板计数。Objective:To explore the short-term efficacy of recombinant human thrombopoietin(rhTPO)as first-line treatment in elderly patients with severe primary immune thrombocytopenia(ITP).Methods:From March 2016 to November 2019,36 elderly patients(aged 65 years or above)with severe ITP were selected from the Department of Hematology,Qingpu Branch of Zhongshan Hospital,Fudan University and the Department of Hematology,Jinshan Hospital,Fudan University,patients were divided into rhTPO combined with classic first-line treatment group(rhTPO group,n=22)and only treated with classic first-line treatment group(control group,n=14).The short-term response rate,time to initial response,peak platelet counts,and time of peak platelet counts between two groups were compared and clinical characteristics possibly correlated with the efficacy of rhTPO were analyzed.Results:The short-term overall response rates in the rhTPO group and control group were 100%(22/22)and 92.9%(13/14),respectively,and the short-term complete response rates were 72.7%(16/22)and 64.3%(9/14),respectively.However,the median time to initial response in the rhTPO group was significantly shorter than that in the control group[4.0(3.0,6.0)d vs 6.0(4.0,7.3)d,P=0.026].In patients who did not receive intravenous immunoglobin and platelet transfusion,peak platelet counts in the rhTPO group were significantly higher than that in the control group[(126.8±42.9)×109/L vs(79.3±42.0)×109/L,P=0.031].Conclusions:First-line treatment combined with rhTPO effectively shortens the time to initial response and increases platelet counts in elderly patients with severe ITP.

关 键 词：免疫性血小板减少症 原发性 重症 重组人血小板生成素 治疗 

分 类 号：R558[医药卫生—血液循环系统疾病]