短疗程甲泼尼龙联合血小板生成素治疗慢性原发免疫性血小板减少症的临床研究

Clinical Study of Short-term Methylprednisolone Combined with Recombinant Human Thrombopoietin in the Treatment of Chronic Immune Thrombocytopenia

目的探讨短疗程甲泼尼龙联合重组人血小板生成素(rhTPO)治疗慢性原发免疫性血小板减少症(ITP)的疗效和安全性。方法选取2018年2月-2019年8月我院收治的慢性ITP患者63例为研究对象,按治疗方法分为观察组33例和对照组30例。对照组给予足疗程甲泼尼龙;观察组给予短疗程甲泼尼龙联合rhTPO。比较2组临床疗效,检测2组治疗前后T淋巴细胞亚群、白介素-10(IL-10)、CTLA-4、转化生长因子-β1(TGF-β1)、血小板生成素(TPO)表达水平。结果观察组临床总有效率显著高于对照组,停药1个月后复发率显著低于对照组(P<0.05)。观察组达到治疗有效的时间短于对照组(P<0.05)。2组血小板数值、TPO表达水平均高于治疗前,且观察组高于对照组(P<0.05)。与治疗前比较,2组治疗后Treg、Th、IL-10、CTLA-4、TGF-β1水平增高,Tc降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论应用短疗程甲泼尼龙联合rhTPO治疗慢性ITP起效快,疗效满意,复发率较低,患者耐受性好,安全性高。

Objective To investigate the clinical efficacy and safety of short-term Methylprednisolone combined with recombinant human thrombopoietin(rhTPO)in the treatment of chronic primary immune thrombocytopenia(ITP).Methods Sixty-three patients with chronic ITP treated in our hospital from February 2018 to August 2019 were selected as the research subjects,and divided into observation group(n=33)and control group(n=30)according to the treatment methods.The control group was given a full course of Methylprednisolone,while the observation group was given a short course of Methylprednisolone combined with rhTPO.The total response rate of the two groups was compared,and the expressions of T lymphocyte subsets,interleukin-10(IL-10),CTLA-4,transforming growth factor-β1(TGF-β1)and thrombopoietin(TPO)were detected before and after treatment.Results The total clinical response rate of the observation group was significantly higher than that of the control group,and the recurrence rate of the observation group was significantly lower than that of the control group at one month after drug withdrawal(P<0.05).The time to reach the therapeutic effect was shorter in the observation group than in the control group(P<0.05).The platelet counts and the levels of TPO of the two groups were higher than those before treatment,which were higher in the observation group than in the control group(P<0.05).After treatment,Treg,Th and the expression levels of IL-10,CTLA-4,TGF-β1 of the two groups were higher than those before treatment,while TC was lower than that before treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).No significant difference was found in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Short course of Methylprednisolone combined with rhTPO in the treatment of chronic ITP has the advantages of fast action,satisfactory curative effect,low recurrence rate and good tolerance.Therefore,it is a safe and effective method for chronic ITP.