吗替麦考酚酯联合糖皮质激素治疗慢性/难治性特发性血小板减少性紫癜的疗效及对患儿血清sHLA-G水平的影响  

Efficacy of mycophenolate mofetil in the treatment of chronic/refractory ITP idiopathic thrombocytopenic purpura and its effect on serum sHLA-G level in children

作　　者：黄惠敏 蔡昌君 温晓梅[1] HUANG Hui-min;CAI Chang-jun;WEN Xiao-mei(Department of Pediatrics,The First Affiliated Hospital of Hainan Medical University,Haikou Hainan 570100,China)

机构地区：[1]海南医学院第一附属医院儿科,海南海口570100

出　　处：《临床和实验医学杂志》2022年第18期1967-1971,共5页Journal of Clinical and Experimental Medicine

基　　金：海南省卫生厅科学研究基金项目(编号:2019B2)。

摘　　要：目的探究吗替麦考酚酯联合糖皮质激素治疗慢性/难治性特发性血小板减少性紫癜(ITP)的疗效及对患儿血清可溶性人类白细胞抗原-G(s HLA-G)水平的影响。方法前瞻性选取2019年1月至2021年1月海南医学院第一附属医院收治的60例ITP患儿作为研究对象,随机数字表法分为观察组(吗替麦考酚酯联合糖皮质激素治疗)与对照组(糖皮质激素治疗)两组,每组各30例。观察3个月,比较治疗前后两组患儿血清炎症因子[白细胞介素(IL)-6、IL-17、肿瘤坏死因子-α(TNF-α)]和s HLA-G水平、血小板计数(PLT)的变化情况,记录治疗情况,随访临床疗效及不良反应发生情况。结果治疗前两组患儿血清IL-6、IL-17及TNF-α水平比较,差异均无统计学意义(P>0.05);治疗后,观察组患儿血清IL-6、IL-17及TNF-α水平均较治疗前明显降低,且为(20.23±3.72)、(23.48±3.03)、(36.20±4.37)ng/L,均明显低于对照组[(26.49±4.56)、(27.28±3.61)、(43.45±4.20)ng/L],差异均有统计学意义(P<0.05)。治疗前,两组患儿血清s HLA-G、PLT水平比较,差异均无统计学意义(P>0.05);治疗后,两组患儿血清s HLA-G较治疗前明显降低,PLT较治疗前明显提高,且观察组血清s HLA-G水平为(6.42±1.04)μg/L,明显低于对照组[(9.16±2.46)μg/L],PLT为(76.65±7.15)×10^(9)/L,明显高于对照组[(56.54±5.36)×10^(9)/L],差异均有统计学意义(P<0.05)。观察组患儿有效止血时间、血小板恢复正常时间为(3.64±1.03)、(6.24±1.09)d,均明显短于对照组[(4.86±1.42)、(9.32±2.56)d],差异均有统计学意义(P<0.05)。观察组患儿治疗总有效率为93.33%,显著高于对照组(70.00%),差异有统计学意义(P<0.05)。两组患儿不良反应发生率比较,差异无统计学意义(P>0.05)。结论吗替麦考酚酯联合糖皮质激素治疗慢性/难治性ITP,在改善患儿炎症因子水平、血小板计数、降低s HLA-G水平方面效果显著,且不增加不良反应,安全可靠,值得临床推广应用。Objective To explore the efficacy of mycophenolate mofetil combined with glucocorticoids in the treatment of chronic/refractory idiopathic thrombocytopenic purpura(ITP)and its effect on serum soluble human leukocyte antigen-G(sHLA-G)levels in children.Methods 60 patients with ITP admitted to The First Affiliated Hospital of Hainan Medical University from January 2019 to January 2021 were prospectively selected as the research objects,and randomly divide them into an observation group(mycophenolate mofetil combined with glucocorticoid therapy)and a control group(glucocorticoid therapy).(Hormone therapy)two groups,30 cases in each group.Observed for 3 months,the changes of serum inflammatory factors[interleukin(IL)-6,IL-17 and tumor necrosis factor-α(TNF-α)]and sHLA-G levels and platelet count(PLT)in the two groups before and after treatment were compared,the treatment conditions were recorded,and the clinical efficacy and adverse reactions were followed up.Results Before treatment,there was no significant difference in serum IL-6,IL-17 and TNF-αbetween the two groups(P>0.05);after treatment,the levels of serum IL-6,IL-17 and TNF-αin the observation group were(20.23±3.72)ng/L,(23.48±3.03)ng/L,(36.20±4.37)ng/L,which were significantly lower than those before treatment,and were significantly lower than those in the control group[(26.49±4.56)ng/L,(27.28±3.61)ng/L,(43.45±4.20)ng/L],the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in levels of serum sHLA-G and PLT between the two groups(P>0.05);the level of serum sHLA-G in the observation group was(6.42±1.04)μg/L,which was significantly lower than that in the control group[(9.16±2.46)μg/L],and the level of PLT was(76.65±7.15)×10^(9)/L,which was significantly higher than that in the control group[(56.54±5.36)×10^(9)/L],the differences were statistically significant(P<0.05).The effective hemostasis time and platelet recovery time in the observation group were(3.64±1.03)d,(6.24±1.09)d,which were

关 键 词：难治性特发性血小板减少性紫癜 吗替麦考酚酯 糖皮质激素 炎症因子 可溶性人类白细胞抗原-G 血小板计数 不良反应 

分 类 号：R725.5[医药卫生—儿科]