目的 比較性研究重組人血小板生成素和免疫球蛋白治療膿毒癥相關(guān)性血小板減少癥的臨床療效。方法 收集2012年1月—2014年3月天津市第一中心醫(yī)院、天津市南開醫(yī)院膿毒癥合并血小板減少癥患者67例,隨機(jī)分為對照組(35例)和治療組(32例)。治療組在對癥治療的基礎(chǔ)上sc重組人血小板生成素注射液300 U/kg,1次/d。對照組在對癥治療的基礎(chǔ)上靜脈點(diǎn)滴人免疫球蛋白400 mg/kg,1次/d。兩組患者血小板計(jì)數(shù)恢復(fù)至100×10⁹/L時(shí)或血小板計(jì)數(shù)絕對值升高≥50×10⁹/L時(shí)即停用升血小板藥。觀察治療前,治療第1、2、3、5、7、9天兩組患者血小板計(jì)數(shù)、Toll4受體(TLR4)、血小板第4因子(PF4)、內(nèi)源性血小板生成素(TPO)的變化。隨訪28 d記錄兩組血液制品的使用情況。結(jié)果 自用藥后第2天開始,兩組患者血小板計(jì)數(shù)均進(jìn)行性升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P < 0.05);治療組較對照組升高的幅度更大(P < 0.05)。從治療第1天開始,兩組TLR4、PF4均較治療前顯著降低(P < 0.05),TPO顯著升高,自治療第5天后對照組TLR4、PF4下降趨勢明顯高于治療組(P < 0.05);自治療第2天開始,治療組TPO顯著高于對照組(P < 0.05)。治療組輸注血小板、血漿、紅細(xì)胞均低于對照組(P < 0.05)。結(jié)論 重組人血小板生成素和免疫球蛋白治療膿毒癥相關(guān)性血小板生成素均有臨床療效,但重組人血小板生成素能在較短時(shí)間內(nèi)提升患者血小板計(jì)數(shù)從而降低了患者早期出血的風(fēng)險(xiǎn)。

Objective To compare the effect of recombinant human thrombopoietin and immunoglobulin in treatment of sepsis associated thrombocytopenia. Methods The patients with sepsis associated thrombocytopenia (67 cases) of the First Central Hospital of Tianjin and Tianjin Nankai Hospital from January 2012 to March 2014 were randomly divided into control (n= 35) and treatment (n= 32) groups. The patients in treatment group were sc administered with Recombinant Human Thrombopoietin Injection on the basis of symptomatic treatment, 300 U/kg, once daily. The patients in the control group were sc administered with immunoglobulin on the basis of symptomatic treatment, 400 mg/kg, once daily. Patients in two groups stopped using increased platelet drugs until platelet count back to 100 × 10⁹ /L above or higher absolute value of platelet count above 50 × 10⁹ /L. The changes of platelet count, TLR4, PF4, and TPO in two groups before treatment, and days 1, 2, 3, 5, 7, and 9 of treatment were observed. Two groups were followed-up for 28 d, and the usages of blood products were recorded. Results Platelet counts in two groups were progressive increase since the second day of treatment, and the difference was statistically significant in the same group (P < 0.05). And the treatment group increased more than the control group (P < 0.05). TLR4 and PF4 in two groups were significantly reduced, while TPO significant increased from the first day of treatment, and downward trend of TLR4 and PF4 in control group was significantly higher than that in the treatment group (P < 0.05). TPO in the treatment group was significantly higher than that in the control group since the second day of treatment (P < 0.05). Infusion of platelet, plasma and red blood cell in treatment group were lower than those in control group (P < 0.05). Conclusion Recombinant human thrombopoietin and immunoglobulin have clinical curative effect in treatment of sepsis associated thrombocytopenia, but recombinant human thrombopoietin can promote the platelet count in a short time so as to reduce the risk of early bleeding.

天津市衛(wèi)生局科技基金資助項(xiàng)目(10KG104)