艾曲波帕对难治性原发免疫性血小板减少症的疗效及其对细胞免疫功能的影响

Efficacy of eltrombopag on refractory primary immune thrombocytopenia and its effect on cellular immune function

探讨艾曲波帕在难治性原发免疫性血小板减少症(ITP)治疗中的临床效果及其对细胞免疫功能的影响。选取2019年1月至2022年10月我院收治的132例难治性ITP患者纳入研究,将其分为联合治疗组(44例)、单一治疗组(44例)和对照组(44例),联合治疗组给予艾曲波帕联合长春地辛治疗,单一治疗组给予艾曲波帕单药治疗,对照组仅给予生活方式干预治疗,疗程均为12周。比较三组临床疗效及不良反应,检测治疗前后三组血小板计数(PLT)、出血时间(BT)、T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+))、B淋巴细胞亚群(CD_(19)^(+)、CD_(20)^(+))、Th1细胞因子(IFN-γ、IL-2)及Th2细胞因子(IL-5、IL-4)水平变化。治疗后,单一治疗组完全反应率明显高于对照组,联合治疗组完全反应率明显高于单一治疗组(均P<0.05)。单一治疗组治疗总有效率高于对照组(P<0.05);联合治疗组总有效率高于单一治疗组(P<0.05)。与对照组比较,单一治疗组治疗后PLT及BT检测值均明显改善(P<0.05);与单一对照组比较,联合治疗组治疗后PLT及BT检测值均明显改善(P<0.05)。与对照组比较,单一治疗组治疗后CD_(4)^(+)/CD_(8)^(+)及CD_(19)^(+)/CD_(20)^(+)均明显改善(P<0.05);与单一治疗组比较,联合治疗组治疗后CD_(4)^(+)/CD_(8)^(+)及CD_(19)^(+)/CD_(20)^(+)均明显改善(P﹤0.05);与对照组比较,单一治疗组及联合治疗组治疗12周后血清IFN-γ、IL-2水平明显较低,而血清IL-5、IL-4水平明显较高(P<0.05);与单一治疗组比较,联合治疗组治疗12周后血清IFN-γ、IL-2水平明显较低,而血清IL-5、IL-4水平明显较高(P<0.05);三组不良反应发生率比较无显著差异(P>0.05)。对于难治性原发免疫性血小板减少症患者,艾曲波帕与免疫抑制剂联合治疗安全有效,利于细胞免疫功能恢复。

To investigate the clinical effects of eltrombopag in treating refractory primary immune thrombocytopenia(ITP)and its impact on cellular immune function,we selected 132 patients with refractory ITP admitted to our hospital between January 2019 and October 2022.They were divided into three groups:the combined treatment group(44 cases),the single treatment group(44 cases),and the complete control group(44 cases).The combined treatment group received etrapopa combined with vindesine,the single treatment group received eltrombopag,and the complete control group only received lifestyle intervention.The treatment course was 12 weeks.We compared the clinical efficacy and adverse reactions of the three groups and collected peripheral blood samples before and after treatment to detect changes in platelet count(PLT),bleeding time(BT),T lymphocyte subsets(CD_(4)^(+),CD_(8)^(+)),B lymphocyte subsets(CD_(19)^(+),CD_(20)^(+)),Th1 cytokines(IFN-γ,IL-2),and Th2 cytokines(IL-5,IL-4).After treatment,the complete response rate in the single treatment group was significantly higher than that in the complete control group,and the complete response rate in the combined treatment group was significantly higher than that in the single treatment group(both P<0.05).The total effective rate in the combined treatment group was also higher than that in the single treatment group(P<0.05).Compared with the complete control group,the PLT and BT values in the single treatment group were significantly improved after treatment(P<0.05),and the combined treatment group had significantly improved PLT and BT values compared to the single treatment group(P<0.05).The CD_(4)^(+)/CD_(8)^(+)and CD_(19)^(+)/CD_(20)^(+)values in the single treatment group were significantly improved after treatment compared with the complete control group(P<0.05),and the combined treatment group showed significantly improved CD_(4)^(+)/CD_(8)^(+)and CD_(19)^(+)/CD_(20)^(+)values compared to the single treatment group(P<0.05).Serum IFN-γand IL-2 levels in the single and combined treatment groups were significantly lower than those in the complete control group after 12 weeks of treatment,while the levels of serum IL-5 and IL-4 were significantly higher(P<0.05).The combined treatment group had significantly higher serum IL-5 and IL-4 levels than the single treatment group after 12 weeks of treatment(P<0.05).The incidence of adverse reactions among the three groups was not significantly different(P>0.05).In conclusion,for patients with refractory primary ITP,combined therapy of eltrombopag and immunosuppressants is safe and effective,improving cellular immune function.