血液肿瘤化疗后血清可溶性白细胞介素-11水平的变化及其意义

Significance and implication of the changes of serum interlukin-11 level in patients with hematological malignancy post-chemotherapy

目的观察血液肿瘤化疗后血清可溶性白细胞介素-11（sIL-11）水平与血小板数量改变的关系，探索能维持血小板安全水平的sIL-11临界值，以指导临床治疗。方法收集血液肿瘤患者化疗前后的血标本，测定sIL-11和血小板水平，观察两者变化间关系并进行统计学分析。结果99例患者完成研究。化疗后患者的sIL-11水平逐步升高，第6天达到峰值后逐渐下降；血小板数量随时间逐步降低，第10天达到最低值，然后逐渐上升；在血小板达到最低之前sIL-11已达峰值；患者化疗后sIL-11越高，血小板数量越有可能维持于较高水平。根据血小板水平最低值将病例分为两组比较，具较高血小板组有较高sIL-11峰值，其sIL-11平均增长速度快，血小板达到最低值的时间较晚，高sIL-11峰值的病例较多。多元回归显示化疗后血小板低于临界值的影响因素有：sIL-11达到最大值的日平均增长速度和化疗第4天sIL-11低于2000pg／ml。结论血液肿瘤患者化疗后sIL-11水平与血小板数量的变化存在相关关系，可以通过测量sIL-11的变化来预测血小板数量的变化趋势。化疗第4天sIL-11〈2000pg／ml的患者发生严重血小板减少的可能性大，建议给予rhIL-11治疗或输注血小板治疗。

Objective To explore the relationship between plasma interleukin-11 （sIL-11） level and platelet count post-chemotherapy with hematological malignancy patients and analyse a sIL-11 level which may maintain a safe platelet count so as to guide the treatment. Methods Blood samples were collected from the patients with hematological malignancy at certain time point of pre-and post-chemotherapy, and serum level of sIL-11 and platelet count were determined separately. Different statistical methods were applied to test the relationship between sIL-11 level and platelet changes. Results 99 cases finished this study. The findings are： the sIL-11 level went up and reached the peak on day 6 post-chemotherapy, while the platelet count kept dropping to the lowest on day 10, the sIL-11 peak occurred before the lowest platelet count, patients with faster sIL-11 increase may maintain a comparatively higher plateled count. 99 cases were grouped according to the lowest platelet count and compared： the group with higher platelet count tend to have higher peak sIL-11, more cases with higher peak sIL-11, with faster daily average sIL-11 increase, the lowest platelet count occurred later. Logistic regression analysis showed the factors contributed to lower platelet includes slower daily average sIL-11 increase and sIL-11 level less than 2000 pg/ml on Day4 post- chemotherapy. Conclusion There were correlation between the serum sIL-11 level and platelet counts, the platelet count change may be predicted by determining the plasma sIL-11 level post-chemotherapy. Patients with sIL-11 level less than 2000 pg/ml on Day4 post-chemotherapy may be endangered with severe thrombocytopenia, rhIL-11 or platelet transfusion treatment should be considered.