环孢素A血药浓度对难治性免疫性血小板减少性紫癜疗效的影响

Analysis of the efficacy of the concentration of cyclosporine A on immune thrombocytopenic purpura

目的探讨环孢素A(Cs A)血药浓度对难治性免疫性血小板减少性紫癜(ITP)临床疗效的影响。方法采用Cs A或联合糖皮质激素治疗难治性ITP患者,检测治疗后前3个月的Cs A浓度和血小板计数(PLT),分析Cs A谷浓度(C0)和峰浓度(C2)对血小板的影响。结果治疗3个月后,12例患者中1例治疗无效,11例PLT上升,增加血药浓度或延长治疗时间可提高部分患者疗效。治疗1个月后,与未显效组比较,显效组中患者C0均>100μg/L,差异有统计学意义(P<0.05);C2的变化无统计学意义(P>0.05)。治疗3个月后,与未显效组比较,C0、C2变化均无统计学意义(P>0.05),即治疗3个月后Cs A血药浓度与疗效无明显相关性。结论加用Cs A可改善难治性ITP预后,维持C0正常范围可增加PLT并保持稳定。

Objectives To analyze the efficacy of the plasma concentration of cyclosporine A（ Cs A） on immune thrombocytopenic purpura（ ITP）. Methods Patients with refractory ITP were treated with Cs A or / and glucocorticoid. Cs A concentration and blood platelet count（ BPC） were detected 1 ~ 3 months after treatment and the influence of the minimum concentration（ C0） and peak concentration（ C2） on blood platelet were analyzed. Results 3 months later,one of 12 patients had no response to treatment and 11 patients had the elevated level of PLT. The increased blood concentration and prolonged treatment time improved the efficacy of patients. 1 months later,compared with the not markedly group,C0 was 100 μg / L in the markedly group,and the difference was statistically significant（ P〈0. 05）; while the difference of C2 between the 2 groups was no statistical significance（ P〈0. 05）.3 months later,compared with the not markedly group,the changes of C0 and C2 were no statistical significance（ P〈0. 05）,which suggested that there was no obvious correlation between therapeutic effect and Cs A blood drug concentration. Conclusions The addition of Cs A could improve the prognosis of refractory ITP,maintained the normal range of C0 as well as increased the level of PLT and keeped it stabile.