重组人血小板生成素治疗肺癌患者化疗或放化疗后血小板减少的临床分析

Clinical analysis of recombinant human thrombopoietin in treating thrombocytopenia due to chemotherapy or chemoradiotherapy in lung cancer patients

目的观察重组人血小板生成素(rh TPO)治疗肺癌患者化疗或放化疗后血小板(PLT)减少的临床疗效及安全性。方法回顾性分析2010年3月至2016年9月在本院确诊为肺癌,化疗或放化疗后PLT计数<75×10~9·L^(-1)的患者177例,均接受rh TPO 15 000 U,皮下注射,qd,14 d为一个疗程,当PLT计数≥100×10~9·L^(-1)或PLT绝对数升高≥50×10~9·L^(-1)时则停药。观察PLT计数恢复时间、输注PLT比例及不良反应发生情况,并对引起PLT减少的因素进行分析。结果经rh TPO治疗后,Ⅱ、Ⅲ、Ⅳ度PLT减少患者PLT开始恢复的时间分别为(4.6±1.9)、(6.8±3.3)和(9.5±5.1)d(P=0.000),仍需输注PLT的比例分别为3%(2/73)、20%(15/74)和70%(21/30)。高龄(≥65岁)、经含吉西他滨和卡铂化疗方案及同步放化疗治疗的患者更容易发生Ⅲ~Ⅳ度PLT减少,需输注PLT的比例更高。14例患者发生轻度不良反应,包括发热6例、寒战2例、头痛2例、膝关节痛2例和乏力2例,均对症处理后缓解或自行缓解。结论 rh TPO可改善肺癌患者化疗或放化疗引起的PLT减少,且安全性较高,在发生Ⅱ度PLT减少时即可使用。

AIM To observe the clinical efficacy and safety of recombinant human thrombopoietin（ rh TPO） in treatment of thrombocytopenia induced by chemotherapy or chemoradiotherapy in lung cancer patients. METHODS A retrospective analysis including 177 lung cancer patients diagnosed in our hospital from March 2010 to September 2016 with platelet（ PLT） count 75 × 109·L-1 after chemotherapy or chemoradiotherapy was conducted. All patients received subcutaneous injection of rh TPO 15 000 U, qd, 14 d for a period. And the rh TPO should be stopped when the PLT count ≥ 100 × 109·L-1 or the absolute number of PLT rose ≥ 50 × 109·L-1. The recovery time of PLT count, infusion ratio of PLT and adverse reactions were observed. And the factors causing the decrease of PLT were analyzed. RESULTS After the treatment, the recovery time of PLT count were（ 4.6 ± 1.9）,（ 6.8 ± 3.3） and（ 9.5 ± 5.1） d for Ⅱ, Ⅲ, Ⅳ degree thrombocytopenia patients, respectively（ P = 0.000）. And the rate of platelet transfusion were 3%（ 2/73）,20%（ 15/74） and 70%（ 21/30）, respectively. The old age（ ≥ 65 years old）, chemotherapy agents containing gemcitabine and carboplatin, and concurrent chemoradiation might more likely to cause Ⅲ-Ⅳ degree thrombocytopenia. Mild adverse reactions occurred in 14 patients including fever（ 6 cases）, chill（ 2 cases）,headache（2 cases）, knee-joint pain（2 cases） and weak（2 cases）. The symptom relieved after symptomatic treatment or alleviated by itself. CONCLUSION rh TPO can improve the degree of thrombocytopenia induced by chemotherapy or chemoradiotherapy in lung cancer patients with high safety. It is suggested that it should be used when Ⅱ degree thrombocytopenia occurs.