磷酸奥司他韦联合丙种球蛋白治疗儿童ITP及对血小板相关指标、体液免疫、血栓相关指标的影响

Effects of oseltamivir phosphate with gammaglobulin on ITP in children and on platelet-related indexes,humoral immunity and thrombus related indexes

目的研究磷酸奥司他韦联合丙种球蛋白治疗儿童免疫性血小板减少症(ITP)及对血小板相关指标、体液免疫、血栓相关指标的影响。方法前瞻性选择2022年6月至2023年6月于沧州市中心医院儿科治疗的ITP患儿60例作为研究对象。按照治疗方法不同将所有ITP患儿分为实验组(n=30)、对照组(n=30)。对照组给予丙种球蛋白治疗,实验组给予磷酸奥司他韦联合丙种球蛋白治疗,两组均治疗14 d。观察两组治疗前及治疗14 d后血小板相关指标[血小板计数(PLT)、血小板平均体积(MPV)、血小板膜糖蛋白CD42b(CD42b)、血小板膜糖蛋白PAC-1(PAC-1)]、血清体液免疫指标(IgA、IgG及IgM)、血清血栓相关指标[纤溶酶原激活抑制物-1(PAI-1)、凝血酶调节蛋白(TM)]和不良反应。采用Logistic回归分析影响磷酸奥司他韦联合丙种球蛋白治疗儿童ITP疗效的因素。结果实验组总有效率为90.00%,高于对照组(60.00%),差异有统计学意义(P<0.05)。治疗14 d后,实验组PLT水平及CD42b、PAC-1表达水平分别为(316.96±34.38)×10^(9)、94.09±9.72、5.59±0.58,均高于对照组[(252.07±28.16)×10^(9)、83.08±8.61、4.49±0.47],MPV水平为(9.95±0.98)fe,低于对照组[(10.94±1.27)fe],差异均有统计学意义(P<0.05)。治疗14 d后,实验组血清IgG水平为(9.18±0.94)g/L,低于对照组[(11.57±1.36)g/L],差异有统计学意义(P<0.05);两组血清IgA及IgM水平比较,差异均无统计学意义(P>0.05)。治疗14 d后,实验组血清PAI-1、TM水平分别为(32.97±3.46)μg/L、(88.06±9.13)ng/mL,均低于对照组[(51.98±5.32)μg/L、(102.95±12.27)ng/mL],差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。不同疗效ITP患儿的性别、出血情况、血小板计数、诱因间比较,差异均无统计学意义(P>0.05);年龄、病程间差异有统计学意义(P<0.05)。经Logistic多因素回归分析,年龄、病程不是影响磷酸奥司他韦联合丙种球蛋白治疗儿童ITP疗效的因素(P<0.05)。结论磷酸奥司他韦联合丙种球蛋白治疗ITP患儿可有效保护PLT,纠正异常体液免疫,改善血栓相关指标水平,具有较高的安全性,且其疗效不受性别、年龄、病程、出血情况、血小板计数、诱因等因素的影响。

Objective To study the effects of oseltamivir phosphate with gammaglobulin on immune thrombocytopenia(ITP)in children and on platelet-related indexes,humoral immunity and thrombus related indexes.Methods A prospective study was conducted on 60 children with ITP who were treated in the Department of Pediatric,Cangzhou Central Hospital from June 2022 to June 2023.According to the different treatment methods,the children with ITP were divided into the experimental group(n=30)and the control group(n=30).The control group was treated with gamma globulin,and the experimental group was treated with oseltamivir phosphate+gamma globulin.Two groups were treated for 14 d.The platelet-related indexes[platelet count(PLT),mean platelet volume(MPV),platelet membrane glycoprotein CD42b(CD42b),platelet membrane glycoprotein PAC-1(PAC-1)],humoral immune indicators(IgA,IgG,IgM),thrombotic related indicators[plasminogen activation inhibitor-1(PAI-1),thrombin regulatory protein(TM)]before treatment and 14 d after treatment,and adverse reactions were observed between the two groups.The factors affecting the efficacy of the combination of oseltamivir phosphate and gammaglobulin in the treatment of pediatric ITP were analyzed using Logistic regression analysis.Results The total response rate of the experimental group was 90.00%,which was higher than that of the control group(60.00%),the difference was statistically significant(P<0.05).At 14 d after treatment,the PLT level and the expression of CD42b and PAC-1 in the experimental group were(316.96±34.38)×10^(9),94.09±9.72,5.59±0.58,respectively,which were higher than those in the control group[(252.07±28.16)×10^(9),83.08±8.61,4.49±0.47],and the MPV level was(9.95±0.98)fe,which was lower than that in the control group[(10.94±1.27)fe],the differences were statistically significant(P<0.05).At 14 d after treatment,the level of serum IgG in the experimental group was(9.18±0.94)g/L,which was lower than that of the control group[(11.57±1.36)g/L],the difference was statistically significant(P<0.05).There were no statistically significant differences in serum IgA and IgM levels between the two groups(P>0.05).At 14 d after treatment,the levels of PAI-1 and TM in the experimental group were(32.97±3.46)μg/L,(88.06±9.13)ng/mL,which were lower than those in the control group[(51.98±5.32)μg/L,(102.95±12.27)ng/mL],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).There were no statistically significant differences in gender,bleeding situation,platelet count and inducement among ITP children with different therapeutic effects(P>0.05).There were statistically significant differences in age and course of disease(P<0.05).Logistic regression analysis showed that age and course of disease were not the factors affecting the efficacy of ITP in children treated with oseltamivir phosphate(P<0.05).Conclusion Oseltamivir phosphate with gammaglobulin treatment in children with ITP can effectively protect PLT,correct abnormal humoral immunity,improve the level of thrombus related indicators,it has a high safety,and its efficacy is not affected by gender,age,course of disease,bleeding,platelet count,inducement and other factors.