重组人血小板生成素治疗恶性血液病化疗后血小板减少简

目的 评价重组人血小板生成素（rhTPO）对恶性血液病化疗后血小板减少的疗效和安全性.方法 化疗后血小板计数≤20×10^9/L的25例急性白血病和恶性淋巴瘤患者,接受方案和剂量相同的两周期化疗,采用病例自身对照研究方法,第一周期（对照组）化疗后出现血小板计数≤20×10^9/L时给予输注血小板悬液;第二个周期（治疗组）化疗结束后,在前述治疗基础上,当血小板计数≤50×10^9/L时给予皮下注射rhTP0 15 000 u,每日1次,连续7d,若未见效,最多延长至14 d;血小板计数≥75×10^9/L或血小板绝对数升高50×10^9/L时停药.监测血常规、肝肾功能、凝血功能、心电图.结果 治疗组和对照组血小板最低平均值为12.4±6.7×10^9/L和（10.8±9.0）×10^9/L,两组差异无统计学意义（P＞0.05）.血小板计数≤20×10^9/L的持续时间治疗组和对照组分别为4.8±1.3 d和6.5±1.7d（P＜0.05）.血小板恢复至≥50×10^9/L、≥75×10^9/L、≥100×10^9/L所需的天数治疗组分别为7.4±1.4 d、9.5±1.5d、11.7±1.8 d,短于对照组的10.3±1.6 d、12.4 ±2.0 d、15.4±2.8 d,两组差异有统计学意义（P＜0.05）.治疗组血小板输注量为13.0±6.8u,对照组血小板输注量为18.5 ±7.6 u,差异有统计学意义（P＜0.05）.治疗组未见严重不良反应.结论 rhTPO能有效促进血小板的恢复,减轻化疗引起的血小板减少程度和持续时间,减少血小板的输注量.

Recombinant Human Thrombopoietinin the Treatment of Thrombocytopenia Induced by Chemotherapy in Patients with Hematological Malignancies

Objective To observation the efficacy and safety of recombinant human thrombopoietin in the treatment of thrombocytopenia induced by chemotherapy in patients with hematological malignancies. Methods 25 acute leukemia and lymphoma patients with platelet count ≤ 20×10^9/L after chemotherapy were enrolled in the current study. They received two courses of chemotherapy with identical regimen and dos- age. The first course（control group） was used as self-control, they were transfused with platelet suspensions when platelet count ≤20×10^9/L after chemotherapy. In the second course（treatment group） ,they were giv- en subcutaneous injection of rhTPO 15 000 u/d for 7 -14 days when platelet count ≤50 ×10^9/L,until the platelet count ≥75 ×10^9/L or the increasing count ≥50 ×10^9/L. Laboratory tests included blood routine,se- rum biochemisty, blood coagulation tests, electrocardiongram. Results The mean minimal platelet count was （12.4 ±6.7） ×10^9/L in the treatment goup versus（ 10.8 ±9.9）×10^9/L in the control group,the difference was no significant（P 〉0.05）. The duration of patients with platelet count ≤20 ×10^9/L was 4.8 ± 1.3 d in the treatment group and 6.5 ± 1.7 d in the control group, the difference was significant（P 〈 0.05 ）. The time of platelet count recovering more than 50×10^9/L,75×10^9/L and 100×10^9/L in the treatment group after chemotherapy was 7.4 ± 1.4 d,9.5 ± 1.5 d and 11.7 ± 1.8 d,compared to 10.3 ± 1.6 d,12.4 ±2.0 d and 15.4 ± 2.8 d in the control group ,the difference was significant（ P 〈 0.05 ）. Platelet transfusion was 13.0 ± 6.8 u in the treatment group and 18.5 ± 7.6 u in the control group, the difference was significant（ P 〈 0.05 ）. No severe side-effect was observed in the treatment group. Conclusion rhTPO can significantly acceleterate PLT recovery, reduce the drgee and duration of thrombocytopenia induced by chemotherapy, and reduce plate-let transfusion.