甲泼尼龙联合rhTPO冲击疗法在儿童难治性ITP中的应用

Application of Methylprednisolone Combined with rHTPO Shock Therapy in Children with Refractory ITP

目的分析甲泼尼龙联合重组人血小板生成素(rhTPO)冲击疗法治疗儿童难治性特发性血小板减少性紫癜(ITP)的临床疗效。方法收集2018年1月至2021年1月安徽医科大学附属亳州医院收治的135例难治性ITP患儿的临床资料,按照治疗方法不同分为甲泼尼龙组、rhTPO组、联合组,各45例。其中,甲泼尼龙组应用甲泼尼龙治疗,rhTPO组应用rhTPO皮下注射治疗,联合组应用甲泼尼龙联合rhTPO皮下注射治疗。比较三组患儿的血小板计数(PLT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平变化,临床疗效以及恶心呕吐、头晕、嗜睡、腹泻等不良反应发生情况。结果不同时点间、组间PLT、TNF-α、IL-6水平的主效应差异有统计学意义(P<0.01);PLT、TNF-α、IL-6水平的时点间与组间存在交互作用(P<0.05),治疗1、2、3、4周,三组患儿的PLT水平均呈逐渐升高趋势,TNF-α、IL-6水平均呈降低趋势,且联合组的PLT水平均高于甲泼尼龙组与rhTPO组,TNF-α、IL-6水平均低于甲泼尼龙组与rhTPO组(P<0.05)。治疗结束后3个月,联合组的总有效率明显高于甲泼尼龙组与rhTPO组[95.56%(43/45)比73.33%(33/45)、71.11%(32/45)](P<0.05),而甲泼尼龙组与rhTPO组的总有效率比较差异无统计学意义(P>0.05)。三组患儿的总不良反应发生率比较差异无统计学意义(χ^(2)=0.760,P=0.684)。结论甲泼尼龙联合rhTPO应用可显著提高难治性ITP患儿PLT水平,治疗效果明显优于单纯应用甲泼尼龙与rhTPO,且不会增加患儿的不良反应发生率。

Objective To analyze the clinical effect of methylprednisolone combined with recombinant human thrombopoietin(rhTPO)in the treatment of refractory idiopathic thrombocytopenic purpura(ITP)in children.Methods A total of 135 children with refractory ITP treated in Bozhou Hospital Affiliated to Anhui Medical University from Jan.2018 to Jan.2021 were included.According to different treatment methods,they were divided into a methylprednisolone group,a rhTPO group and a combination group,with 45 cases in each group.The combination group was treated with methylprednisolone combined with rhTPO subcutaneous injection,the methylprednisolone group was treated with methylprednisolone,and the rhTPO group was treated with rhTPO subcutaneous injection.The levels of platelet count(PLT),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),clinical efficacy as well as occurrence of adverse reactions such as nausea and vomiting,dizziness,drowsiness,diarrhea were compared among the three groups.Results There were statistically significant differences in the main effect of PLT,TNF-αand IL-6 levels between the three groups and different time points(P<0.01).There was interaction in PLT,TNF-αand IL-6 levels between different time points and groups(P<0.05).After 1,2,3 and 4 weeks of treatment,PLT levels in the three groups showed a gradually increasing trend,while TNF-αand IL-6 levels showed a decreasing trend,and PLT level in the combination group were higher than those in the methylprednisolone group and the rhTPO group,while the levels of TNF-αand IL-6 were lower than those in the methylprednisolone group and the rhTPO group(P<0.05).3 months after the end of treatment,the total effective rate in the combination group was significantly higher than that in the methylprednisolone group and the rhTPO group[95.56%(43/45)vs 73.33%(33/45),71.11%(32/45)](P<0.05).There was no significant difference in total effective rate between the methylprednisolone group and the rhTPO group(P>0.05).There was no significant difference in the incidence of total adverse reactions among the three groups(χ^(2)=0.760,P=0.684).Conclusion Combined use of methylprednisolone and rhTPO can significantly improve the PLT level of refractory ITP children,and the therapeutic effect is significantly better than that of methylprednisolone or rhTPO alone,without increasing the incidence of adverse reactions in the children.