糖皮质激素治疗HIV相关免疫性血小板减少症患者疗效的影响因素

Influencing factors of glucocorticoids therapeutic effect in patients with HIV related imumune thrombocytopenia

目的分析影响糖皮质激素治疗人类免疫缺陷病毒(HIV)相关免疫性血小板减少症(ITP)患者疗效的可能因素。方法回顾性分析2016年1月至2020年12月该院收治的40例经糖皮质激素治疗有效的HIV相关ITP患者的临床资料(有效组,依据相关标准评估为完全反应、有效患者)和40例经糖皮质激素治疗无效的HIV相关ITP患者的临床资料(无效组,依据相关标准评估为无效患者),收集并记录两组患者性别、年龄等一般资料,分析HIV相关ITP患者应用糖皮质激素疗效的影响因素。结果无效组患者治疗前血清P-糖蛋白(PGP)、白细胞介素-17(IL-17)、HIV-RNA水平均明显高于有效组,且血清血小板(PLT)、外周血CD4^(+)T淋巴细胞水平均明显低于有效组,差异均有统计学意义(P<0.05);两组患者其他临床指标比较,差异均无统计学意义(P>0.05);治疗前PGP、IL-17过表达、HIV-RNA高水平是HIV相关ITP患者糖皮质激素治疗无效的影响因素(优势比>1,P<0.05);治疗前PLT、CD4+T淋巴细胞低水平是HIV相关ITP患者糖皮质激素治疗无效的影响因素(优势比<1,P<0.05)。结论治疗前血清PGP、IL-17过表达、HIV-RNA高水平,以及PLT、CD4^(+)T淋巴细胞低水平均可能是HIV相关ITP患者糖皮质激素治疗无效的影响因素。

Objective To analyze the possible influencing factors of the glucocorticoids therapeutic effect in the patients with human immunodeficiency virus(HIV)related immune thrombocytopenia(ITP).Methods The clinical data in 40 patients with HIV related ITP effectively treated by glucocordicoids effective group,which was evaluated as the patients with complete response and effect according to the related standard and 40 patients with HIV related ITP ineffectively treated by glucocorticoids(ineffective group,which was evaluated as the ineffective patients according to the related standard)in this hospital from January 2018 to December 2020 were retrospectively analyzed.The general data such as sex and age were collected and recorded in the two groups.Then the influencing factors of glucocorticoids therapeutic effect in the patients with HIV related ITP were analyzed.Results The levels of serum P-glycoprotein(PGP),interleukin-17(IL-17)and HIV-RNA before treatment in the ineffective group were significantly higher than those in the effective group,moreover the levels of serum platelet count(PLT)and peripheral blood CD4^(+)T lymphocytes were significantly lower than those in the effective group,and the differences were statistically significant(P<0.05);there was no statistically significant difference in other clinical indicators between the two groups(P>0.05);the overexpression of PGP and IL-17 and high level of HIV-RNA before treatment were the influencing factor of the ineffective glucocorticoid treatment in the patients with HIV related ITP(OR>1,P<0.05);the low levels of PLT and CD4+T lymphocytes before treatment were the influencing factor of the ineffective treatment of glucocorticoid in the patients with HIV related ITP(OR<1,P<0.05).Conclusion The overexpression of serum PGP,IL-17,high level of HIV-RNA and low levels of PLT and CD4^(+)T lymphocytes before treatment may be the influencing factor of the ineffective treatment of glucocorticoid in the patients with HIV related ITP.