血必净联合重组人血小板生成素治疗脓毒症相关性血小板减少症中的有效性及对TLR4、PF4、TPO的影响  

Efficacy of Xuebijing combined with recombinant human thrombopoietin in the treatment of sepsis associated thrombocytopenia and its effect on TLR4,PF4 and TPO

作　　者：侯宇[1] 苏醒 敖雪[1] 管军 谢斌[1] 魏光明 HOU Yu;SU Xing;AO Xue(Department of Critical Medicine,Haikou Hospital Affiliated to Xiangya Medical College,Central South University,Haikou Hainan 570208,China.)

机构地区：[1]中南大学湘雅医学院附属海口医院重症医学科,海南海口570208 [2]空军军医大学第二附属医院核医学科,陕西西安710038

出　　处：《临床和实验医学杂志》2022年第12期1276-1279,共4页Journal of Clinical and Experimental Medicine

基　　金：海南省卫生计生行业科研项目(编号:19A200164)。

摘　　要：目的探究血必净联合重组人血小板生成素治疗脓毒症相关性血小板减少症中的有效性及对血清TOLL样受体4(TLR4)、血小板因子4(PF4)、血小板生成素(TPO)的影响。方法前瞻性选取2018年3月至2021年6月中南大学湘雅医学院附属海口医院接收的脓毒症相关性血小板减少症患者88例,根据治疗方案不同将其分为对照组(n=44)和观察组(n=44)。对照组接受重组人血小板生成素治疗,观察组在对照组治疗方案基础上施加血必净。比较两组的临床疗效、TLR4、PF4、TPO指标变化、免疫功能以及血小板计数的影响。结果观察组总有效率为90.91%,低于对照组(75.00%),差异有统计学意义(P<0.05)。治疗前,两组TLR4、PF4、TPO指标水平、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)指标水平、血小板计数差异均无统计学意义(P>0.05);治疗后15 d,观察组TLR4、PF4、TPO水平为(97.04±10.66)、(109.38±10.39)、(104.28±20.11)pg/mL,均低于对照组[(120.70±12.37)、(120.11±12.51)、(170.36±29.50)pg/mL],差异均有统计学意义(P<0.05);治疗后15 d,观察组CD4^(+)、CD4^(+)/CD8^(+)水平为(46.19±7.24)%、1.86±0.49,高于对照组[(40.07±6.19)%、1.42±0.41],CD8^(+)为(23.24±3.38)%、低于对照组[(30.03±4.55)%],差异均有统计学意义(P<0.05);治疗后5、10、15 d,观察组血小板计数为(68.28±6.11)×10^(9)/L、(86.39±8.19)×10^(9)/L、(119.05±11.19)×10^(9)/L,均高于对照组[(57.04±5.27)×10^(9)/L、(70.18±7.04)×10^(9)/L、(94.29±9.09)×10^(9)/L],差异均有统计学意义(P<0.05)。观察组不良反应发生率较对照组高,但差异无统计学意义(P>0.05)。结论血必净联合重组人血小板生成素治疗脓毒症相关性血小板减少症可有效调节TLR4、PF4、TPO指标水平,提高机体免疫功能,改善血小板计数,促进整体疗效提升,且不会增加不良反应发生率,值得推广应用。Objective To explore the efficacy of Xuebijing combined with recombinant human thrombopoietin in the treatment of sepsis associated thrombocytopenia and its effects on serum toll like receptor 4(TLR4),platelet factor 4(PF4)and serum thrombopoietin(TPO).Methods A total of 88 patients with sepsis associated thrombocytopenia received in Haikou Hospital Affiliated to Xiangya Medical College,Central South University from March 2018 to June 2021 were prospectively selected.According to the treatment scheme,they were divided into control group(n=44)and observation group(n=44).The control group was treated with recombinant human thrombopoietin,and the observation group was treated with Xuebijing on the basis of the treatment scheme of the control group.The curative effect,changes of TLR4,PF4,TPO,immune function and platelet count were compared between the two groups.Results Compared with the control group,the total effective rate of the observation group was 90.91%,which was lower than 75.00%of the control group,the difference was statistically significant(P<0.05).There was no significant difference in TLR4,PF4,TPO index levels,CD4^(+),CD8^(+),CD4^(+)/CD8^(+) index levels and platelet count between the two groups before treatment(P>0.05).The levels of TLR4,PF4,and TPO in the observation group were(97.04±10.66)pg/mL,(109.38±10.39)pg/mL,(104.28±20.11)pg/mL,which were lower than those in the control group[(120.70±12.37)pg/mL,(120.11±12.51)pg/mL,(170.36±29.50)pg/mL]at 15 days after treatment,the differences were statistically significant(P<0.05).The indexes of CD4^(+),CD4^(+)/CD8^(+) in the observation group were(46.19±7.24)%,1.86±0.49,which were higher than those in the control group[(40.07±6.19)%,1.42±0.41]at 15 days after treatment,and CD8^(+)was(23.24±3.38)%,which was lower than that in the control group[(30.03±4.55)%],the differences were statistically significant(P<0.05).The platelet count of the observation group were(68.28±6.11)×10^(9)/L,(86.39±8.19)×10^(9)/L,and(119.05±11.19)×10^(9)/L,which were hi

关 键 词：血必净 重组人血小板生成素 脓毒症相关性血小板减少症 免疫功能 血小板计数 

分 类 号：R459.7[医药卫生—急诊医学]