阿伐曲泊帕对进行侵入性手术的慢性肝病相关重度血小板减少症的疗效

Efficacy of avatrombopag on chronic liver disease thrombocytopenia in patients undergoing invasive surgery

目的观察阿伐曲泊帕对计划进行侵入性手术的慢性肝病(chronic liver disease,CLD)相关重度血小板减少症(thrombocytopenia,TCP)患者的治疗效果。方法选取计划进行侵入性手术的CLD相关重度TCP患者80例,按照随机数字表法分为观察组和对照组,每组40例。在计划进行侵入性手术前5~8 d,对照组给予重组人血小板生成素(recombinant human thrombopoietin,rhTPO)治疗,观察组给予阿伐曲泊帕治疗,疗程均为5 d。比较2组血小板计数(platelet count,PLT)变化,术后7 d内无需血小板输注或任何原因出血抢救患者的比例,肝功能[丙氨酸氨基转移酶(alanine aminotransferase,ALT)和天冬氨酸氨基转移酶(aspartate transaminase,AST)]、总胆红素(total bilirubin,TBiL)和白蛋白(albumin,ALB),门静脉血栓(portal vein thrombosis,PVT)形成和不良反应发生情况。结果治疗前,2组ALT、AST、TBiL和ALB水平比较差异均无统计学意义;术后7 d,2组的ALT、AST和TBiL水平均较治疗前升高,ALB均降低(P<0.05),2组4项生化指标比较差异均无统计学意义。治疗后,观察组PLT升高达到进行侵入性手术(PLT≥50×10^(9)·L^(−1))要求的比例(97.50%)高于对照组(80.00%),P<0.05;观察组PLT在用药后第4天开始上升,至第13天达到高峰,在第35天后下降至基线水平;对照组PLT在用药后第6天开始上升,至第14天达到高峰,在第21天后下降至基线水平;且观察组在用药后第4、6、8、10、12、13、14、21天的PLT均高于对照组(P<0.05)。观察组术后7 d内无需血小板输注或任何原因出血抢救患者的比例(87.18%)高于对照组(62.50%),P<0.05。治疗后1个月复查腹部B超,2组均未见PVT形成。2组药物不良反应发生率比较差异无统计学意义(P>0.05)。结论阿伐曲泊帕用于CLD相关重度TCP患者的侵入性手术操作前可显著升高血小板水平,降低血小板输注需求,且PVT形成风险和不良反应均未增加,患者耐受性良好。

Objective To observe the therapeutic effect of avatrombopag in patients with chronic liver disease(CLD)-related severe thrombocytopenia(TCP)planning to undergo invasive surgery.Methods 80 CLD-related severe TCP patients who were scheduled to undergo invasive surgery in our hospital were selected and divided into observation group and control group according to random number table method,with 40 cases in each group.Five to eight days before the planned invasive surgery,the control group was given recombinant human thrombopoietin(rhTPO)treatment,while the observation group was given avatrombopag for 5 days.The changes in platelet count(PLT),the proportion of patients who were rescued without platelet transfusion or bleeding from any cause within 7 days after surgery,liver function[alanine aminotransferase(ALT)and aspartate transaminase(AST)],total bilirubin(TBiL)and albumin(ALB),portal vein thrombosis(PVT)formation and the incidence of adverse reactions were compared.Results Before treatment,there was no significant difference in the levels of ALT,AST,TBiL and ALB between the 2 groups.On the 7th day after operation,the levels of ALT,AST and TBiL in both groups were increased compared with those before treatment,and the ALB was decreased(P<0.05).However,there was no significant difference in the 4 biochemical indexes between the 2 groups on the 7th days after operation.After treatment,the proportion of PLT elevation in the observation group meeting the requirements for invasive surgery(PLT≥50×10^(9)·L^(−1))was(97.50%)higher than that in the control group(80.00%)(P<0.05).With the prolongation of medication time,the PLT in the observation group began to increase on the 4th day after medication,reached a peak on the 13th day,and decreased to the baseline level after the 35th day.The PLT in the control group began to increase on the 6th day after administration,reached a peak on the 14th day,and decreased to the baseline level after the 21st day.The PLT of the observation group was higher than that of the control group on the 4th,6th,8th,10th,12th,13th,14th,and 21st days after treatment(P<0.05).The proportion of patients in the observation group who did not need platelet transfusion or bleeding for any reason within 7 days after surgery was(87.18%)higher than that in the control group 62.50%,P<0.05.There was no PVT formation in either group.There was no significant difference in the incidence of adverse drug reactions between the 2 groups(P>0.05).Conclusion Avatrombopag can significantly increase platelet levels and reduce platelet transfusion requirements before invasive surgery in patients with CLD-related severe TCP,without increasing the risk of PVT formation and adverse reactions,and the patients are well tolerated.