艾曲波帕与大剂量人免疫球蛋白联合激素治疗儿童慢性免疫性血小板减少性紫癜的疗效对比

Analysis on efficacy of eltrombopag and high-dose immunoglobulin combined with glucocorticoid in treating children chronic immune thrombocytopenic purpura

目的对比艾曲波帕及大剂量免疫球蛋白联合激素治疗慢性免疫性血小板减少性紫癜(cITP)患儿的临床疗效及不良反应。方法选取我院医学中心小儿血液与肿瘤科2009年7月~2020年8月收治的51例cITP患儿为研究对象,其中男性23例,女性28例,年龄3~15岁,平均(7.65±2.31)岁。51例cITP患儿分为艾曲波帕治疗组(n=19)与免疫球蛋白联合激素治疗组(n=32)。定期监测所有患儿肝肾功能、凝血功能、心肌酶谱及心电图检查。结果治疗后,两组患儿出现完全反应、反应、持续反应、无效情况比较,差异无统计学意义(P>0.05)。两组在治疗前及治疗后7 d、14 d、1个月血小板计数恢复情况比较,差异无统计学意义(P>0.05);治疗后3个月,两组血小板计数比较,差异有统计学意义(P<0.05)。艾曲波帕治疗组不良反应发生率为15.79%,免疫球蛋白联合激素治疗组为71.88%;两组患儿不良反应发生率比较,差异有统计学意义(P<0.05)。结论艾曲波帕及大剂量免疫球蛋白联合激素治疗cITP,在促进血小板回升的疗效上基本相似,但艾曲波帕在提升血小板过程中作用更持久,疗效不易反弹,不良反应更少。

Objective To observe the efficacy and adverse reaction of eltrombopag and high-dose immunoglobulin combined with glucocorticoid treating patients with cITP.Methods 51 cases of children patients with cITP were divided into the two groups.Of which,19 cases received the treatment of elthrombopag,32 cases received treatment that combined immunoglobulin and glucocorticoid,liver and renal function,coagulation function,myocardial enzyme spectrum and ECG examination were monitored routinely.Results The occurrence of complete response,response,durable response and no response of these the two groups of children patients were compared after different treatments,the difference is not statistically significant(P>0.05).The recovery status of PLT count after treatments were compared,Prior to treatment and 7 days,14 days,1 month after treatments,the difference of PLT count in these the two groups is not statistically significant(P>0.05),but 3 month after treatment,the difference of PLT count in these the two groups is statistically significant(P<0.05).The comparison between the adverse reaction rate in these the two groups showed that the rate in elthrombopag treatment group was 15.79%and the rate in treatment group of immunoglobulin combined with glucocorticoid was 71.88%,and the difference of the adverse reaction rate is statistical significance(P=0.000).Conclusion Efficacy of eltrombopag and high-dose immunoglobulin combined with glucocorticoid in treating cITP is basically similar to the efficacy of promoting the recovery of PLT count,however,eltrombopage has a more lasting effect in the process of PLT enhancement,the effect is not easy to rebound,and there are fewer adverse reactions.