重组人血小板生成素在难治性血小板减少性紫癜中的应用

目的评价重组人血小板生成素(rhTPO)对难治性特发性血小板减少性紫癜(ITP)的疗效和安全性。方法将35例难治性ITP患者分为3组,试验1组(12例):应用rhTPO联合达那唑;试验2组(8例):单用rhTPO;对照组(15例):单用达那唑。结果试验1组:用药前,血小板计数的中位数为6(1～15)×109/L;治疗后第14天,血小板为97(43～136)×109/L(P<0.01);停药后,血小板计数逐渐回落,至开始治疗后28 d,血小板计数降至48(22～76)×109/L。试验2组:用药前,血小板计数的中位数为6(2～13)×109/L;治疗后第14天,血小板为93(33～152)×109/L(P<0.01),第28天血小板计数降至32(12～44)×109/L。试验组近期有效率为80%,其中显效9例(45%),良效7例(35%)。30%患者使用TPO达有效的平均时间为7 d,达峰值为13 d。对照组近期有效率为73%,其中显效6例(40%),良效5例(33.3%)。第14天,试验组与对照组血小板计数比较,差异有统计学意义(P<0.01),第28天差异无统计学意义(P>0.05)。结论 rhTPO治疗难治性ITP安全、有效,rhTPO联合达那唑比单用达那唑起效快,能更好地控制出血症状。

Application of recombinant human thrombopoietin on refractory idiopathic thrombocytopenic purpura

Objective To evaluate the efficacy and safety of human recombinant thrombopoietin(rhTPO) on refractory idiopathic thrombocytopenic purpura(ITP).Methods 35 patients with ITP were divided into three groups:test group 1(treated with rhTPO combined danazol,n=12),test group 2(only use rhTPO,n=8),control group(only use danazol,n=15).Results The median counts of platelet in test group 1 was 6(1.0~15.0)×109/L before medication;the maximum value increased to 97(43~136)×109/L after 14 d of treatment(P<0.01);after stopping drugs,the platelet count decreased gradually to 48(22~76)×109/L at 28 d after medication.The median counts of platelet in test group 2 was 6(2~13)×109/ L before medication;the maximum value increased to 93(33~152)×109/L after given rhTPO for 14 d(P<0.01);After stopping rhTPO,the platelet count decreased gradually to 32(12~44)×109/L at 28 d after medication.In test group,the recent effective rate was 80%,the remarkable rate was 45%,and the positive rate was 35%.The average time of reaching the effective point of TPO in 30% of patients was 7 d,and the peak value was achieved at 13 th day.In control group,the recent effective rate was 73%,the remarkable rate was 40%,and the positive rate was 33.3%.Conclusion rhTPO has good and safe effect on refractory ITP.rhTPO combined with danazol has faster onset of action than danazol,and it could control bleeding symptoms better.