脾切除治疗原发性免疫性血小板减少症61例回顾性临床分析  

Primary immune thrombocytopenia treated by splenectomy:a retrospective analysis of 61 cases

作　　者：徐圆 侯鹏霄 薛峰 刘晓帆 刘葳 陈云飞 付荣凤 杨仁池 李慧媛 张磊 XU Yuan;HOU Pengxiao;XUE Feng;LIU Xiaofan;LIU Wei;CHEN Yunfei;FU Rongfeng;YANG Renchi;LI Huiyuan;ZHANG Lei(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin Key Laboratory of Gene Therapy for Blood Diseases,CAMS Key Laboratory of Gene Therapy for Blood Diseases,Tianjin,300020,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津市血液病基因治疗研究重点实验室,中国医学科学院血液病基因治疗重点实验室,天津300020

出　　处：《临床血液学杂志》2023年第5期321-326,331,共7页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:82070125,82170127)。

摘　　要：目的:评估在血小板生成素受体激动剂等新药背景下脾切除术的疗效、安全性以及确定脾切除术后疗效的预测因素。方法:分析2014年1月—2021年12月进行脾切除术的61例原发性免疫性血小板减少症(primary immune thrombocytopenia,ITP)患者。结果:脾切除术后的PLT峰值中位数为393×10^(9)/L,达到PLT峰值的中位时间为5 d。54例(88.5%)患者达到了初始有效,7例(11.5%)患者疗效评定为无效。在进行随访后(中位随访时间为33个月),27例持续有效,24例出现ITP的复发,中位复发时间为2个月。脾切除术前最低PLT为脾切除术后疗效的重要预测因子(P=0.037)。未出现围手术期死亡患者,19例(31.1%)患者出现感染,2例(3.3%)患者出现血栓。结论:脾切除术是一种安全的治疗ITP的方式,能达到较高的持续有效率,切脾前最低的PLT显示出对切脾后疗效的预测价值。Objective To evaluate the current efficacy and safety of splenectomy in the context of new drugs such as thrombopoietin receptor agonists and to determine the predictors of efficacy after splenectomy.Methods A total of 61 patients with primary immune thrombocytopenia(ITP)who were admitted to our hospital from January 2014 to December 2021 and underwent splenectomy during this period were analyzed.Results The median platelet peak value after splenectomy was 393×10^(9)/L,and the median time to reach platelet peak value was 5 days.Among the 61 patients,54 patients(88.5%)achieved initial response,and 7 patients(11.5%)were evaluated as NR.After follow-up(median follow-up,33 months),27 patients had sustained response,and 24 patients experienced relapse of ITP,with a median time of 2 months.The lowest platelet count before splenectomy was an important predictor of postoperative efficacy(P=0.037).There were no perioperative deaths,infection occurred in 19 patients(31.1%),and thrombosis occurred in 2 patients(3.3%).Conclusion Splenectomy is a safe method to treat ITP,which can achieve a high rate of sustained response.The lowest platelet count before splenectomy has predictive value of postoperative efficacy.

关 键 词：原发性免疫性血小板减少症 脾切除术 回顾性分析 

分 类 号：R558.2[医药卫生—血液循环系统疾病]