目的 探討重組人血小板生成素（rhTPO）對吉西他濱聯(lián)合卡鉑（GC）或吉西他濱聯(lián)合順鉑（GP）方案化療相關(guān)血小板減少癥（CIT）二級預(yù)防的優(yōu)化方案。方法 2019年3月—2020年6月，在內(nèi)蒙古自治區(qū)人民醫(yī)院、河南大學(xué)腫瘤醫(yī)院共招募非小細(xì)胞肺癌（NSCLC）患者60例，此60例患者行GP/GC方案化療，前1個化療周期中血小板計(jì)數(shù)最低值<50×10⁹·L^-1，且經(jīng)治療已恢復(fù)正常，60例患者隨機(jī)分為對照組和試驗(yàn)組，每組各30例，對照組患者在下1個化療周期第2、4、6、9天預(yù)防性給予重組人血小板生成素（rhTPO），試驗(yàn)組患者在下1個化療周期第3、4、6天預(yù)防性給予rhTPO，監(jiān)測兩組患者的血小板計(jì)數(shù)變化，并進(jìn)行對比分析。結(jié)果 試驗(yàn)組和對照組3度以上血小板減少癥的發(fā)生率分別為40%、30%，兩組比較差異無統(tǒng)計(jì)學(xué)意義；試驗(yàn)組血小板最低值為（38±13）×10⁹·L^-1，對照組為（45±17）×10⁹·L^-1，兩組對比差異無統(tǒng)計(jì)學(xué)意義；試驗(yàn)組和對照組化療后血小板計(jì)數(shù)低于100×10⁹·L^-1的持續(xù)時間分別為（9±3）、（7±4）d，兩組比較差異顯著（P<0.05）；試驗(yàn)組和對照組化療后血小板低于50×10⁹·L^-1的持續(xù)時間分別為（4±3）、（3±2）d，兩組比較差異無統(tǒng)計(jì)學(xué)意義。預(yù)防用藥結(jié)束后，試驗(yàn)組有14例患者繼續(xù)給予rhTPO治療，rhTPO中位使用支數(shù)為3支（1～7支）；對照組有13例患者繼續(xù)給予rhTPO治療，rhTPO中位使用支數(shù)為3支（1～6支），兩組非參數(shù)秩和檢驗(yàn)，差異無統(tǒng)計(jì)學(xué)意義。試驗(yàn)組有1例、對照組有2例患者血小板過低或伴有明顯出血傾向，給予輸注血小板。結(jié)論 rhTPO在吉西他濱聯(lián)合鉑類化療方案的第3、4、6天3 d用藥方案相較傳統(tǒng)4 d方案，療效及安全性無明顯差異，但能減少患者住院天數(shù)，降低治療費(fèi)用。

Objective To explore the optimal scheme of recombinant human thrombopoietin (rhTPO) for the secondary prevention of chemotherapy-related thrombocytopenia (CIT) with gemcitabine combined with carboplatin (GC) or gemcitabine combined with cisplatin (GP).Methods From March 2019 to June 2020, 60 patients with non-small cell lung cancer (NSCLC) were recruited from the people's Hospital of Inner Mongolia Autonomous Region and the Cancer Hospital of Henan University. These 60 patients underwent GP/GC chemotherapy. The lowest platelet count in the first chemotherapy cycle was less than 50×10⁹·L^-1 and returned to normal after treatment. 60 patients were randomly divided into control group and experimental group, the patients in the control group were given rhTPO on the 2nd, 4th, 6th and 9th day of the next chemotherapy cycle, the patients in the experimental group were given rhTPO prophylactically on the 3rd, 4th and 6th day of the next chemotherapy cycle, the changes of platelet count in the two groups were monitored and compared. Results The incidence of thrombocytopenia above grade three in the experimental group and the control group were 40% and 30% respectively, and there was no significant difference between two groups. The lowest platelet value in the experimental group was (38 ±13)×10⁹·L^-1, the control group was (45 ±17)×10⁹·L^-1, there was no significant difference between the two groups. The duration of platelet count was lower than 100×10⁹ · L^-1 after chemotherapy of the experimental group and the control group was (9 ±3) and (7 ±4) d, respectively, there was significant difference between two groups (P < 0.05). The duration of platelet count was lower than 50×10⁹ ·L^-1 after chemotherapy of the experimental group and the control group was (4 ±3) and (3 ±2) d, respectively, and there was no significant difference between the two groups. After the end of preventive medication, 14 patients in the experimental group continued to be treated with rhTPO, and the median number of rhTPO was three branch (1-7 branchs), 13 patients in the control group continued to be treated with rhTPO, and the median number of rhTPO was three branches (1-6 branches), there was no significant difference between the two groups by nonparametric rank sum test. One patient in the experimental group and two patients in the control group were given platelet transfusion because of low platelet or obvious bleeding tendency. Conclusion Compared with the traditional four day regimen, optimal scheme of rhTPO administered on days 2rd, 4th, and 6th of gemcitabine combined with platinum chemotherapy regimen has no significant difference in efficacy and safety, but it can reduce the length of hospital stay and treatment cost.

R973

國家自然科學(xué)基金資助項(xiàng)目（81860534）；內(nèi)蒙古自治區(qū)科技計(jì)劃項(xiàng)目（2019GG039，2021GG0167）；內(nèi)蒙古自然科學(xué)基金資助項(xiàng)目（2021MS08152）；三生TCP青年基金資助項(xiàng)目（20180048）；北京醫(yī)學(xué)獎勵基金會基金資助項(xiàng)目（YXJL-2020-0785-0315）；河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃（2018020746）；三生TCP中青年科研基金資助項(xiàng)目（20180008）