维甲酸联合达那唑治疗难治性免疫性血小板减少症的效果及对血清IL-6、IL-10及NK细胞水平的影响

Curative effect of retinoic acid combined with danazol on refractory immune thrombocytopenia and its influences on levels of serum IL-6,IL-10 and NK cells

目的 探讨维甲酸联合达那唑治疗难治性免疫性血小板减少症(ITP)的效果及对血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及自然杀伤(NK)细胞水平的影响。方法 选取2020年1月至2022年6月郑州大学第二附属医院收治的难治性ITP患者78例为研究对象。采用随机数字表法分为对照组与观察组,每组39例。对照组给予达那唑治疗,观察组给予维甲酸联合达那唑治疗,两组均持续治疗16周。比较两组临床疗效,治疗前后7 d、14 d、21 d血小板计数变化,治疗前后外周血T淋巴细胞和NK细胞水平、血清IL-6、IL-10水平;并比较两组不良反应发生情况及3个月内复发情况。结果 治疗后,观察组治疗总有效率(89.74%,35/39)高于对照组(69.23%,27/39),差异有统计学意义(χ^(2)=5.032,P=0.025<0.05);3个月内,观察组复发率低于对照组(χ^(2)=4.768,P=0.029<0.05)。治疗后,两组血小板计数均显著升高(P<0.05),且治疗后7 d、14 d、21 d观察组血小板计数较高(P<0.05)。治疗后,观察组与对照组CD4^(+)、CD4^(+)/CD8^(+)和NK细胞水平均升高(P<0.05),且观察组水平较高(P<0.05)。治疗后,观察组与对照组血清IL-10水平均升高、IL-6水平均降低(P<0.05),且观察组血清IL-10水平较高、IL-6水平较低(P<0.05)。观察组不良反应发生率(15.38%,6/39)与对照组(17.95%,7/39)比较差异未见统计学意义(χ^(2)=0.092,P=0.761>0.05)。结论 维甲酸联合达那唑治疗难治性ITP效果显著,且能降低复发率,其作用机制可能与改善患者体内免疫性炎症状态有关。

Objective To investigate the curative effect of retinoic acid combined with danazol on refractory immune thrombocytopenia(ITP) and its influences on levels of serum interleukin-6(IL-6),interleukin-10(IL-10) and natural killer(NK) cells.Methods Seventy-eight patients with refractory ITP admitted to the Second Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were selected as the research subjects.The patients were divided into control group and observation group using a random number table method,with 39 cases in group.The control group was treated with danazol,while the observation group was treated with retinoic acid combined with danazol.Both groups continued treatment for 16 weeks.The clinical efficacy,the changes in platelet counts on days 7,14,and 21 before and after treatment,the levels of peripheral blood T lymphocytes and NK cells,as well as serum IL-6 and IL-10 levels before and after treatment of the two groups were compared,and the incidence of adverse reactions and recurrence within 3 months between the two groups were compared.Results After treatment,the total effective rate of clinical treatment in the observation group(89.74%,35/39) was higher than that in the control group(69.23%,27/39),and the difference was significant(χ^(2)=5.032,P=0.025<0.05);Within 3 months,the recurrence rate in the observation group was lower than that in the control group(χ^(2)=4.768,P=0.029<0.05).After treatment,the platelet counts of both groups significantly increased(P<0.05),and the observation group had a higher platelet counts on the 7th,14th,and 21st days after treatment(P<0.05).After treatment,the levels of CD4^(+),CD4^(+)/CD8^(+),and NK cells in the observation group and control group both increased(P<0.05),and the levels in the observation group were higher(P<0.05).After treatment,both the observation group and the control group had an increase in serum IL-10 levels and an average decrease in IL-6 levels(P<0.05),while the observation group had higher serum IL-10 levels and lower IL-6 levels(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(15.38%,6/39) and the control group(17.95%,7/39)(χ^(2)=0.092,P=0.761>0.05).Conclusions Curative effect of retinoic acid combined with danazol is significant on refractory ITP,which can reduce the recurrence rate.The mechanism of may be related to the improvement of immune inflammation in patients.