原发免疫性血小板减少症患者二线治疗的研究新进展

Research advances on second-line treatment of patients with immune thrombocytopenia

原发免疫性血小板减少症(ITP)是由抗体介导的血小板破坏和血小板产生受损引起的获得性出血性疾病。ITP治疗目的包括减少出血事件,诱导持续缓解和改善患者生活质量。ITP标准一线治疗方案为糖皮质激素和静脉注射免疫球蛋白(IVIG),虽然该方案可以提高多数患者的血小板计数,但是停药后复发率较高。目前,随着对ITP研究的深入,各种新治疗靶点被不断发现,多种不同作用机制的二线治疗药物逐渐进入临床。笔者拟就血小板生成素受体激动剂(TPO-RA)、新生儿Fc受体(FcRn)抑制剂、脾酪氨酸激酶(SYK)抑制剂、Bruton酪氨酸激酶(BTK)抑制剂、去甲基化药物和单克隆抗体等ITP患者二线治疗的研究新进展进行阐述,旨在为提高ITP患者的缓解率、降低复发率提供理论依据。

Primary immune thrombocytopenia(ITP)is caused by antibody-mediated platelet destruction and impaired platelet production.The goals of treatment include reducing bleeding events,inducing sustained remission and improving quality of life.The standard first-line regimen is glucocorticoid and intravenous immunoglobulin(IVIG).Although this regimen improves platelet counts in many ITP patients,there is a high rate of recurrence after discontinuation.At present,with the deepening of ITP research,various new treatment targets are constantly being discovered,and a variety of second-line treatment drugs with different mechanisms of action are gradually entering clinical practice.This article intends to elaborate on the latest research progress in second-line treatment of ITP patients such as thrombopoietin receptor agonist(TPO-RA),neonatal Fc receptor(FcRn)inhibitor,spleen tyrosine kinase(SYK)inhibitor,Bruton tyrosine kinase(BTK)inhibitor,hypomethylating drugs,monoclonal antibodies,etc.,aiming to provide a theoretical basis for improving the remission rate and reducing the recurrence rate of ITP patients.