免疫球蛋白治疗脓毒症相关性血小板减少症的疗效

Treatment of septic thrombocytopenia with immunoglobulin

目的探讨静脉注射用人血免疫球蛋白(intravenous Immunoglobulin,IVIG)对脓毒症相关性血小板减少症的辅助治疗作用。方法将52例出现血小板减少的脓毒症患者随机分成治疗组和对照组。治疗组在综合治疗的基础上加用IVIG 400mg/(kg·d),每天1次,连用5d。观察两组患者血小板计数、出血倾向,危重病评分的变化；并采用ELASA法对两组患者体内促炎因子白介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumour necrosis factor-α,TNF-α)的浓度进行检测,观察IVIG对脓毒症患者促炎介质水平的影响。结果治疗组患者在治疗后第3天血小板计数开始明显上升,上升幅度明显高于对照组；活动性出血发生率明显低于对照组(P＜0．05)；治疗组患者血TNF-α浓度和APACHEIⅡ评分在治疗后3d时点以及IL-6浓度在治疗后1、3、7d时点较对照组明显下降(P＜0．05)。结论采用IVIG治疗脓毒症相关血小板减少症,血小板可迅速上升,进而改善患者的出血倾向,并降低脓毒症患者的促炎因子水平。

Objective To investigate the effects of intravenous immunoglobulin （IVIG） on thrombocytopenia associated with sepsis. Methods Fifty-two septic thrombocytopenia patients were randomly devided into IVIG group and control group, with 26 patients in each group. IVIG with dose of 400 mg/ （kg·d） for 5 days was intravenously administered together with conventional treatment in IVIG group. Before and after IVIG treatment, platelet （PLT） counts, TNF-α, IL-6 and APACHE Ⅲ score were determined. Results In treatment group platelet counts were increased after IVIG treatment at 3 and 7 days in the IVIG group （ P 〈 0.05）; The bleeding rate and APACHE Ⅱ were significantly lower than control group, TNF-α level was lower at 3 days after treatment than eortrol group, and IL-6 level was lower at 1, 3, and 7 days （ P 〈 0.05）. Conclusion The use of IVIG to treat septic thrombocytopenia leads to a rapid and great increase in platelet count and significantly reduce the incidence of bleeding episode and TNF-α, IL-6 level and APACHEⅢ score.