重组人白细胞介素-11对伴血小板减少的脓毒症患者治疗作用的研究

Therapeutic effects of rhIL - 11 on sepsis patients combined with thrombocytopenia

目的：观察重组人白细胞介素－11（rhIL－11）对脓毒症相关血小板（PLT）减少的治疗效果，探讨rhIL－11抗炎作用的机制。方法80例伴PLT减少的脓毒症患者随机分为干预组（ T组）及对照组（ C 组），两组均接受疾病所需的常规治疗，干预组加用 rhIL －1125μg／（kg· d）皮下注射，共7 d，PLT＞100×109／L时，停止给药；观察第1、3、5、7、9天两组患者外周静脉血中PLT计数，以及脂多糖（LPS）、肿瘤坏死因子－α（TNF－α）、C－反应蛋白（CRP）、降钙素原（ PCT）等炎症指标，随访入住ICU时间及28 d的病死率。结果第3天开始T组PLT计数明显高于C组，差异有统计学意义；第3～9天各观察时间点，T组PCT、LPS、TNF－α低于C组，差异有统计学意义；随访28 d内，C组病死率27．5％，T组病死率12．5％。 T组无严重不良事件发生。结论 rhIL－11能显著改善伴有PLT减少症的脓毒症患者PLT计数，能降低脓毒症患者的炎症反应，降低28 d病死率。

Objective To observe the platelet recovering and anti -inflammatory effects of recombinant human interleukin - 11 （rhIL - 11 ） on the patients with sepsis who combined with thrombocytopenia, and to explore its possible mechanism. Methods Eighty patients with sepsis combined with thrombocytopenia were divided into treatment group （ rhIL - 11 group） and control group （conventional therapy group ） randomly. All the patients received active antibiotics and other comprehensive treatment, rhIL- 11 group were given subcutaneous injection of rhIL- 11 25 txg/（ kg ~ d）additionaUy for 7 days. When the platelet counts increased to 100 ~ 109/L, the injection was discontinued. The peripheral platelet counts were observed on the first, third, fifth, seventh, and ninth day after the treatment. Inflammatory markers （ LPS, TNF - ct, CRP, PCT）, the length of ICU stay, and 28 - day mortality were compared between two groups. Results After the third day platelet count in rhlL - 11 group was significantly higher than that in control group （ P 〈 0.05 ） ; PCT, LPS and TNF - ct values of rhlL - 11 group were lower than the conventional treatment group from the third day to the ninth day. Mortality of conventional treatment group within 28 days was significantly higher than that of rhlL - 11 treatment group （27.5% vs 12.5% ）. There were no severe adverse event in rhlL- 11 group. Conclusion RhlL - 11 has a protective role and can accelerate recovery of platelets, and remarkably lessen the extent of inflammatory responses, hence reducing the mortality in sepsis patients accompanied with thrombocytopenia.