【摘要】 目的探讨重组人血小板生成素(rhTPO)治疗儿童原发免疫性血小板减少症(ITP)的疗效及安全性。方法回顾性分析2016年1月至2017年12月在西安市儿童医院治疗的35例ITP患儿,经过常规糖皮质激素及静脉丙种球蛋白治疗无效,均单独给予rhTPO治疗,观察应用rhTPO治疗前后血小板计数(PLT)的变化及不良反应的发生情况。结果全部35例患儿中,完全反应19例,有效反应7例,无效9例,总有效率为74.29%。全部患儿用药前平均PLT计数为(13.8±4.7)×109/L,治疗后PLT最高值平均为(135.1±54.9)×109/L,PLT计数治疗后较治疗前有明显升高(t=2.292,P<0.05)。在新诊断ITP、持续性ITP、慢性ITP患儿中治疗有效率分别为75.00%、76.47%、71.43%,不同分期患儿有效率比较差异无统计学意义(P>0.05)。治疗有效者PLT开始上升的中位时间为5(3～9)天,PLT达最高值平均中位时间为11(7～16)天。治疗有效者停用TPO后1周,PLT计数逐渐下降,但无显著的出血表现,停用rhTPO 2周时,PLT平均值较治疗前仍显著升高,差异有统计学意义(t=1.698,P<0.05)。应用rhTPO期间,有1例发生轻微皮疹,其余患儿在用药及随访过程中未发现其他不良反应。结论 rhTPO治疗儿童ITP疗效较好,安全性高,可以有效提升血小板水平,减轻出血倾向。更多还原

【Abstract】 Objective To investigate the efficacy and safety of recombinant human thrombopoietintin(rhTPO)in the treatment of primary immune thrombocytopenia(ITP)in children.Methods Retrospective analysis was conducted among 35 children with ITP treated in Xi’an Children’s Hospital from January 2016 to December 2017.Routine glucocorticoids and intravenous immune globulin treatment were ineffective,and rhTPO alone was given to all cases.The changes of platelet count and the incidence of adverse reactions before and after treatment were observed.Results Of these 35 patients,19 were completely responsive,7 were effective,and 9 were ineffective with total effective rate of 74.29%.The average PLT count before treatment was(13.8±4.7)×109/L,and the highest average PLT after treatment was(135.1±54.9)×109/L.The PLT count was significantly higher than that before treatment(t=2.292,P<0.05).The effective rates of children with newly diagnosed ITP,persistent ITP and chronic ITP were 75.00%,76.47% and 71.43%,respectively.There was no significant difference in the efficiency among children with different stages(P>0.05).The median time for PLT starting to rise was 5(3-9)days,and the average median time for highest PLT was 11(7-16)days.One week after the discontinuation of TPO,the PLT count gradually decreased,but there was no significant bleeding performance.The median PLT was significantly higher than that before treatment(t=1.698,P<0.05)when rhTPO was stopped for 2 weeks.During the application of rhTPO,one patient developed mild rash,and no other adverse reactions were found in the other children during the medication and follow-up.Conclusion Application of rhTPO is effective in treating children with ITP,and it has high safety.It can effectively increase platelet level and reduce bleeding tendency.更多还原