氨磷汀联合低剂量环孢素治疗难治性免疫性血小板减少症的机制

Mechanism of amifostine combined with low dose cyclosporine in refractory immune thrombocytopenia

目的 探讨氨磷汀联合低剂量环孢素治疗难治性免疫性血小板减少症的效果与相关机制。方法 将60例难治性免疫性血小板减少症患者采用平行随机对照分组,分3组,每组20例,氨磷汀组单用氨磷汀,环孢素组单用环孢素,氨磷汀＋环孢素组实施氨磷汀＋环孢素A治疗。观察3组的血小板计数、血小板膜糖蛋白抗体、淋巴细胞亚群分析,骨髓巨核细胞数量等指标,并进行比较。结果 3组经不同的治疗之后,不同时间与治疗前进行比较血小板计数水平均显著上升,且治疗之后3、6个月,氨磷汀组与环孢素组的血小板计数水平均显著低于氨磷汀＋环孢素组,差异均有统计学意义（P〈0.05）,氨磷汀组与环孢素组比较差异无统计学意义;氨磷汀＋环孢素组的治疗总有效率显著高于其余2组,差异有统计学意义（P〈0.05）,氨磷汀组与环孢素组比较差异无统计学意义;治疗后3组的血小板膜糖蛋白抗体GPIIb/IIIa水平均出现显著增高,且氨磷汀＋环孢素组治疗后的检测水平显著高于其余2组,差异有统计学意义（P〈0.05）;氨磷汀组与环孢素组比较差异无统计学意义;治疗后3组的CD4^＋、CD4^＋/CD25^＋、CD4^＋/CD8^＋水平均显著提高,CD8^＋水平显著下降,差异有统计学意义（P〈0.05）。且氨磷汀＋环孢素组治疗后的变化幅度水平显著高于其余2组,差异有统计学意义（P〈0.05）;氨磷汀组与环孢素组比较差异无统计学意义;治疗后3组骨髓巨核细胞数量经计数每片个数与本组治疗前比较均显著减少,氨磷汀＋环孢素组治疗后的计数水平显著低于其余2组,差异有统计学意义（P〈0.05）;氨磷汀组与环孢素组比较差异无统计学意义;氨磷汀组和氨磷汀＋环孢素组的不良反应发生率均显著低于环孢素组,差异有统计学意义（P〈0.05）;氨磷汀组和氨磷汀＋环孢素组比较差异无统计学意义。结论 氨磷汀联合低剂量环孢素治疗难治性免疫性血小板减少症能发挥出增效作用,提高治疗效果,并有效减少环孢素剂量及不良反应。

Objective To explore the effect of amifostine combined with low-dose cyclosporine in treatment of refractory immune thrombocytopenia effect and related mechanisms.Methods 60 cases of refractory immune thrombocytopenia patients using parallel randomized controlled groups, divided into three groups, 20 cases in each group, amifostine group were treated with amifostine, cyclosporine group were treated with cyclosporine, amifostine＋CSA group received amifostine＋cyclosporine A treatment.The platelet count, platelet membrane glycoprotein antibody, lymphocyte subsets and bone marrow megakaryocyte count were observed and compared.Results After different treatment of three, six months, the level of platelet count of patients in three groups were compared with the group before treatment were significantly increased, and the treatment of platelet count level of amifostine group and cyclosporine group were significantly lower than that of amifostine ＋CSA group, the difference was statistically significant （P〈0.05）, there was no significant difference between amifostine group and cyclosporine group.The total efficacy of amifostine＋CSA group was significantly higher than the other two groups, the difference was statistically significant （ P〈0.05 ） , there was no significant difference between amifostine group and cyclosporine group.After the treatment, the platelet membrane glycoprotein GPIIb/IIIa antibody levels in three groups were significantly increased, and ring the detection level of amifostine＋CSA group after treatment was significantly higher than the other two groups, the difference was statistically significant （P〈0.05）, there was no significant difference between amifostine group and cyclosporine group.After treatment, the three groups of CD4^＋, CD4^＋/CD25^＋and CD4^＋/CD8^＋levels were significantly increased, CD8^＋decreased significantly, the difference was statistically significant （P〈0.05）.And the level of change after treatment with amifostine ＋cyclosporine group was significantly higher than that of the other two groups, the difference was statistically significant （P〈0.05）, there was no significant difference between amifostine group and cyclosporine group.After treatment, the number of bone marrow megakaryocytes in the three groups was significantly lower than that before treatment , the level of count after treatment with amifostine ＋cyclosporine was significantly lower than that of the other two groups, the difference was statistically significant （P〈0.05）.there was no significant difference between amifostine group and cyclosporine group.The adverse reactions of amifostine group and amifostine＋CSA group were significantly lower than that in cyclosporine group, the difference was statistically significant （P〈0.05）.there was no significant difference between amifostine group and amifostine＋CSA group.Conclusion Amifostine combined with low dose of cyclosporine in treatment of refractory immune thrombocytopenia can play a synergistic effect, improve the therapeutic effect, and effectively reduce the dosage and adverse reactions.