阿伐曲泊帕治疗等待肝移植患者重度血小板减少症的疗效分析

Analysis of therapeutic effect of avatrombopag on patients with severe thrombocytopenia waiting for liver transplantation

目的研究阿伐曲泊帕对等待肝移植患者伴重度血小板减少症(thrombocytopenia,TCP)的治疗作用。方法通过回顾郑州大学第一附属医院2021年2月至2022年10月间67例等待肝移植并伴重度TCP患者的临床资料,收集患者一般情况资料及阿伐曲泊帕使用前后患者血小板计数情况。治疗后血小板计数升至≥50×10^(9)/L为治疗有效。根据是否联合应用重组人血小板生成素(recombinant human thrombopoietin,rhTPO)将患者分为两组(单药治疗组和联合治疗组)进行分析。结果在伴有重度TCP的67例等待肝移植患者中,应用阿伐曲泊帕治疗后患者血小板计数与治疗前相比显著升高(P=0.001),其中89.55%(60/67)的患者治疗后血小板计数升至≥50×10^(9)/L,有效率在不同程度的血小板减少组间无统计学差异(P=0.373)。亚组分析表明,联合治疗组治疗后血小板计数显著高于单药治疗组(P=0.002),而用药前血小板计数无统计学差异(P=0.064)。在单药治疗组中85.00%(34/40)患者血小板计数升至≥50×10^(9)/L,联合治疗组(27例)中96.30%(26/27)患者治疗后血小板计数升至≥50×10^(9)/L,两组间比较不具有统计学差异(P=0.228)。结论阿伐曲泊帕可提高伴有重度TCP等待肝移植患者的血小板水平,与rhTPO联用可能存在叠加作用。

Objective To study the therapeutic effect of avatrombopag on severe thrombocytopenia(TCP)in patients waiting for liver transplantation.Methods This study was conducted by analyzing the clinical data of 67 patients waiting for liver transplantation with severe TCP in the First Affiliated Hospital of Zhengzhou University from February 2021 to October 2022.The general information of patients and their platelet count before and after avatrombopag treatment were collected in this study.Patients were divided into two groups for further analysis according to whether recombinant human thrombopoietin(rhTPO)was used at same time.Platelet count no less than 50×10^(9)/L after treatment of avatrombopag was considered as effective response.Results The platelet count of 67 patients waiting for liver transplantation with severe TCP was significantly elevated after using avatrombopag(P=0.001).Moreover,the platelet counts of 89.55%(60/67)patients were higher than 50×10^(9)/L and there was no significant difference in the effective rate between different thrombocytopenia groups(P=0.373).Further analysis showed that combined therapy group(avatrombopag and rhTPO)acquired significant higher platelet count than monotherapy group(P=0.002)with similar basal count level before treatment(P=0.064).Furthermore,the percentage of patients whose platelet counts were more than 50×10^(9)/L had no significant difference(P=0.228)between avatrombopag group 85.00%(34/40)and combined group 96.30%(26/27).Conclusion Avatrombopag could increase the platelet level in severe TCP patients waiting for liver transplantation.Avatrombopag combined with rhTPO may have better therapeutic effect.