重组人血小板生成素治疗恶性血液病化疗后血小板减少的临床观察

Clinical observation of treatment with recombinant human thrombopoietin on chemotherapy - induced thrombocytopenia in patients with hematological malignancies

目的评价国产重组人血小板生成素（rhTPO）对恶性血液病患者化疗后血小板减少的临床疗效和安全性。方法化疗后血小板≤20×10 9／L的12例白血病和淋巴瘤患者接受方案和剂量相同的2个周期化疗，第1周期作为自身对照，第2周期当血小板≤50×10 9／L时皮下注射rhTPO15000U／d为用药组，连续用药8～14d（血小板升至t〉75×10 9／L停用），监测血及尿常规、肝肾功能、凝血功能。结果用药组血小板最低平均值（11±4）×10 9／L与对照组（9．4±2．9）×10 9／L比较，差异无统计学意义（P〉0．05），血小板〈20×10 9／L的持续天数用药组为（7．6±2．0）d，和对照组[（8．7±2．2）d]比较差异有统计学意义（P〈0．05）。血小板恢复最高值分别为（253±86）×10 9／L和（178±53）×10 9／L，差异有统计学意义（P〈0．05）。血小板输注量用药组为（21．7±3．9）u，对照组为（24．2±5．1）u，差异无统计学意义（P〉0．05）。用药组未见严重不良反应。结论rhTPO可减少恶性血液病化疗后血小板降低的持续时间，提高血小板恢复后水平，且具有良好的安全性。

Objective To evaluate the safety and effectiveness of rhTPO on the treatment of chemotherapy- induced thrombocytopenia in patients with hematological malignancies. Methods Twelve leukemia and lymphoma patients with platelet count ≤20 × 10 9/L after chemotherapy were enrolled in the current study. They received two courses of chemotherapy with identical regimen and dos- age. The first course was used as self- control. In the second course, rhTPO was subcutaneously administered at a dosage of 15 000 U/d for 8 - 14 clays （until the platelet count ≥75 × 10 9/L） when platelet count ≤50 × 10 9/L. Laboratory tests included blood routine and urine routine, serum biochemisty, blood coagulation tests. Results The mean minimal platelet count was（11 ±4） × 10 9/L in the treatment goup versus（9.4 ±2.9） × 10 9/L in the control group, the difference was no significant （P 〉 0.05）. The duration of patients with platelet count 〈 20 × 10 9/L was（7.6 ± 2.0） d in the treatment group and （8.7 ± 2.2） d in the control group, the difference was significant （P 〈 0.05 ）. The mean maximal platelet count in patients＇ recovery period was（253 ± 86） × 10 9/L and（ 178 ± 53） × 10 9/L respectively, the difference was significant （P 〈0.05 ）. Platelet transfusion was（21.7 ± 3.9）U in the treatment group and（24.2± 5.1 ） U in the control group, the difference was nor significant （P 〉 0.05 ）. No severe side - effect was observed in the treatment group. Conclusions rhTPO could reduce the duration of chemotherapy - induced thrombocytopenia in patients with hematological malignancies and elevate the platelet count and without severe side- effect.