阿法骨化醇联合泼尼松治疗成人初发确诊的原发免疫性血小板减少症40例临床观察  

Clinical observation of alfacalcidol combined with prednisone in the treatment of 40 adults with initially diagnosed primary immune thrombocytopenia

作　　者：李琦[1] 康虹阳 范凌[1] 张灵[1] 刘洁[1] 佟长青[1] 张斌[2] LI Qi;KANG Hongyang;FAN Ling;ZHANG Ling;LIU Jie;TONG Changqing;ZHANG Bin(Department of Hematology,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院血液病科,河北张家口075000 [2]河北北方学院附属第一医院检验科,河北张家口075000

出　　处：《山东医药》2022年第27期36-40,共5页Shandong Medical Journal

基　　金：河北省医学科学研究课题计划项目(20200505)。

摘　　要：目的观察阿法骨化醇联合泼尼松治疗成人初发确诊的原发免疫性血小板减少症(ITP)的临床疗效,以及治疗前后患者外周血淋巴细胞维生素D受体(VDR)、调节性T细胞(Treg)/辅助性T细胞(Th)17和血清1,25-双羟维生素D_(3)[1,25(OH)_(2)D_(3)]、高迁移率族蛋白B1(HMGB1)、干扰素-γ(IFN-γ)水平的变化。方法80例成人初发确诊的ITP患者,采用随机数字表法分成观察组与对照组各40例。观察组采用阿法骨化醇联合泼尼松治疗,即口服阿法骨化醇软胶囊,0.5μg/次,1次/d,连续治疗6周;口服醋酸泼尼松片,以1 mg/(kg·d)为起始剂量(最大日剂量80 mg),分3次服用,起效后应尽快减量至最小维持量(<15 mg/d),并于6~8周停用。对照组单用泼尼松治疗,用法、用量及疗程同观察组。连续治疗6周后观察两组疗效。比较治疗前后两组外周血血小板计数(PLT)、淋巴细胞VDR水平和Treg、Th17比例及血清1,25(OH)_(2)D_(3)、HMGB1、IFN-γ水平。统计两组不良反应情况。结果观察组总有效率为95.00%(38/40),对照组为75.00%(30/40),两组相比,P<0.05。两组治疗2、4、6周时外周血PLT逐渐升高,且均高于治疗前(P均<0.05),以观察组为著(P均<0.05)。治疗后,两组血清1,25(OH)_(2)D_(3)水平升高;外周血淋巴细胞VDR水平、Th17比例降低,Treg/Th17升高;血清HMGB1、IFN-γ水平降低;均以观察组为著(P均<0.05)。观察组治疗后外周血Treg比例较治疗前升高(P均<0.05),对照组治疗前后比较,P>0.05。两组不良反应率比较,P>0.05。结论阿法骨化醇联合泼尼松治疗成人初发确诊ITP整体疗效确切,且安全性较好;可能是通过提高患者血清1,25(OH)_(2)D_(3)水平,下调外周血淋巴细胞VDR表达以及降低血清HMGB1、IFN-γ水平,调控Treg/Th17免疫平衡起作用的。Objective To observe the clinical effects of alfacalcidol combined with prednisone in the treatment of adults with initially diagnosed primary immune thrombocytopenia(ITP),and the changes in levels of peripheral blood lymphocytes Vitamin D receptor(VDR),regulatory T Cell(Treg)/Helper T Cell(Th)17,serum 1,25-dihydroxyvitamin D_(3)[1,25(OH)_(2)D_(3)],high-mobility group protein B1(HMGB1)and interferon-γ(IFN-γ)before and after treatment.Methods Eighty adult patients with initially diagnosed ITP were randomly divided into the observation group and control group with 40 cases in each.The patients in the observation group were treated with alfacalcidol combined with prednisone,namely oral administration of alfacalcidol soft capsules,0.5μg/time,once a day,for 6 weeks;oral administration of prednisone acetate tablets,1 mg/(kg·d)was the starting dose(the maximum daily dose was 80 mg),which was taken in three doses,after it took effect,the dose was reduced to the minimum maintenance dose(<15 mg/d)as soon as possible,and it stopped taking within 6 to 8 weeks.The patients in the control group were treated with prednisone alone.The usage,dosage,and course of treatment were the same as those in the observation group.The curative effects of the two groups were observed after 6 weeks of continuous treatment.The peripheral blood platelet count(PLT),lymphocyte VDR,proportion of Treg and Th17,and the levels of serum 1,25(OH)_(2)D_(3),HMGB1,and IFN-γwere analyzed between the two groups before and after treatment.The adverse reactions rates of the two groups were counted.Results The total effective rate was 95.00%(38/40)in the observation group and 75.00%(30/40)in the control group(P<0.05).The peripheral blood PLT increased gradually at 2,4,and 6 weeks after treatment in the two groups,which were higher than those before treatment(all P<0.05),especially in the observation group(P<0.05).After treatment in the two groups,the serum 1,25(OH)_(2)D_(3)levels increased.Peripheral blood lymphocyte VDR levels and Th17 ratio decreased,and

关 键 词：阿法骨化醇 泼尼松 原发免疫性血小板减少症 维生素D受体 1 25-双羟维生素D3 Treg/Th17细胞 高迁移率族蛋白B1 Γ干扰素 

分 类 号：R453.9[医药卫生—治疗学] R558.2[医药卫生—临床医学]