大剂量地塞米松联合血小板生成素治疗免疫性血小板减少症临床观察

Clinical effect of large dose of dexamethasone combined with thrombopoietin in the treatment of immune thrombocytopenia

目的评价大剂量地塞米松联合血小板生成素(TPO)治疗免疫性血小板减少症(ITP)的疗效及其对患者细胞免疫功能的影响。方法选取2015年6月至2018年1月就诊于广东医科大学附属医院的92例ITP患者,根据随机数表法分为对照组和联合组各46例。所有患者均接受大剂量地塞米松治疗,联合组在此基础上加用TPO治疗,30 d后比较两组患者的临床疗效、用药安全性,并观察治疗前后两组患者的血小板计数(PLT)和T、B淋巴细胞水平。结果联合组患者的治疗总有效率为91.30%,明显高于对照组的71.74%,差异有统计学意义(P<0.05);治疗7 d、14 d后,两组患者的PLT水平均呈上升趋势,联合组分别为(49.26±21.15)×109/L、(110.32±46.58)×109/L,均高于对照组的(40.61±20.47)×109/L、(92.15±40.27)×109/L,差异均有统计学意义(P<0.05);治疗30 d后,联合组患者的CD4+、CD4+/CD8+分别为(40.26±6.18)%、(1.34±0.64),均高于对照组的(34.11±5.76)%、(1.04±0.52),CD8+、CD19+/CD20+分别为(30.08±7.36)%、(15.17±4.49),均低于对照组的(36.82±9.36)%、(19.25±5.11),差异均有统计学意义(P<0.05);用药和随访期间联合组患者的不良反应发生率为4.35%,略低于对照组的13.04%,但差异无统计学意义(P>0.05)。结论大剂量地塞米松联合TPO治疗ITP有利于提高患者的PLT水平,调节免疫功能,其疗效确切且用药安全性较高。

Objective To evaluate the efficacy of large dose of dexamethasone combined with thrombopoietin(TPO) in the treatment of immune thrombocytopenia(ITP) and its influence on cellular immunity of patients.Methods A total of 92 ITP patients in the Affiliated Hospital of Guangdong Medical University from June 2015 to January 2018 were selected, and they were divided into control group and combined group by random number table, with46 patients in each group. All the patients were treated with large dose of dexamethasone, and on this basis, the combined group was additionally treated with TPO. The clinical efficacy and medication safety of patients in the two groups were compared after 30 days. The changes of blood platelet(PLT), T, B lymphocyte before and after treatment were observed. Results The total effective rate of the combined group(91.30%) was significantly higher than that in the control group(71.74%), P<0.05. After treatment for 7 d and 14 d, the PLT levels of two groups showed an increasing trend,but the levels in the combined group were significantly higher than those in the control group:(49.26 ± 21.15) × 109/L vs(40.61±20.47)×109/L for 7 d, P<0.05;(110.32±46.58)×109/L vs(92.15±40.27)×109/L for 14 d, P<0.05. After treatment for 30 d, the CD4+, CD4+/CD8+in combined group were(40.26±6.18)%,(1.34±0.64), which were significantly higher than(34.11±5.76)%,(1.04±0.52) in the control group, and the CD8+and CD19+/CD20+in the combined group were(30.08±7.36)%,(15.17±4.49), significantly lower than(36.82±9.36)%,(19.25±5.11) in the control group, all with statistically significant differences(P<0.05). The incidence of adverse reactions in the combined group during medication and follow-up(4.35%) was slightly lower than that in control group(13.04%), but there was no statistically significant difference(P>0.05). Conclusion Large dose of dexamethasone combined with TPO in treatment of ITP can increase the levels of PLT and regulate immune function, which has definite efficacy and higher medication safety.