【摘要】 目的：探讨慢性原发免疫性血小板减少症(CITP)患者应用海曲泊帕停药的预测因素及其预测价值。方法：回顾性分析河南省中医院2020年8月至2025年5月确诊为CITP并规律口服海曲泊帕≥6个月的患者84例，随访时间为3-15个月，按是否达到停药后持续反应(SROT)将患者分为SROT组(停用海曲泊帕后持续血小板反应即PLT>30×10~9/L且无出血事件，持续至少3个月)及非SROT组(未能达到SROT者)。收集患者口服海曲泊帕前CD4~+与CD8~+T细胞比值、CD19~+与CD45~+细胞比值、血小板与淋巴细胞比值、中医证型及减停周期等指标。采用单因素分析、多因素二元Logistic回归分析CITP患者停药后持续反应的影响因素，通过受试者工作特征(ROC)曲线分析其预测价值。结果：84例CITP患者中，SROT组40例，非SROT组44例。两组间药程与病程比值、骨髓巨核细胞数目、身体质量指数、年龄、血小板计数等不存在统计学差异。两组间CD4~+与CD8~+T细胞比值、CD19~+与CD45~+细胞比值、减停周期及中医证型(血热妄行证、阴虚内热证)存在统计学差异。二元Logistic回归分析显示，减停周期是CITP患者停药的保护因素(P<0.05);CD19~+与CD45~+细胞比值是风险因素。ROC曲线分析显示，减停周期、CD19~+与CD45~+细胞比值及其联合检测诊断CITP患者应用海曲泊帕达到SROT的曲线下面积(areaunderthecutve,AUC)分别为0.708、0.750和0.825；联合诊断的AUC高于各项单独检测(P<0.05)。结论：减停周期是CITP患者停药的保护因素，CD19~+与CD45~+细胞比值是风险因素。联合检测减停周期、用药前CD19~+与CD45~+细胞比值对CITP患者应用海曲泊帕是否能达到SROT具有较高的预测效能。更多还原

【Abstract】 Objective:To explore the predictive factors and predictive value for sustained response off treatment(SROT) with hetrombopag in patients with chronic primary immune thrombocytopenia(CITP).Methods:A retrospective analysis was conducted on 84 patients diagnosed with CITP who received regular oral hetrombopag for ≥6months at Henan Provincial Hospital of Traditional Chinese Medicine from August 2020 to May 2025.The follow-up period was 3-15 months.Patients were divided into the SROT group(patients who achieved sustained platelet response after hetrombopag discontinuation,i.e.,PLT>30 × 10~9/L with no bleeding events for at least 3 months) and the nonSROT group(those who failed to achieve SROT).Factors including ratio of CD4~+to CD8~+T cells,ratio of CD 19~+to CD45~+cells,Platelet-to-lymphocyte ratio,duration of drug withdrawal,and TCM syndrome types(Blood-heat agitation syndrome,Yin deficiency with internal heat syndrome,Qi deficiency failing to control blood syndrome,Blood stasis internal obstruction syndrome) were collected.Univariate analysis and binary logistic regression were used to analyze the influencing factors of sustained response off treatment with hetrombopag in CITP patients,and the predictive value was assessed through receiver operating characteristic(ROC) curve analysis.Results:Among the 84 CITP patients,40 were assigned to the SROT group and 44 to the non-SROT group.No statistically significant differences were observed in baseline data(ratio of treatment duration to disease duration,bone marrow megakaryocyte count,body mass index,age,and platelet count) between the two groups.Univariate analysis revealed significant differences between the two groups in ratio of CD4~+to CD8~+T cells,ratio of CD 19~+to CD45~+cells,duration of drug withdrawal,and TCM syndrome types(Blood-heat agitation syndrome,Yin deficiency with internal heat syndrome).These factors were incorporated into binary logistic regression analysis,which showed that duration of drug withdrawal was a protective factor for achieving SROT(P <0.05),while the ratio of CD 19 to CD45 cells was a risk factor.ROC curve analysis indicated that the areas under the curve(AUC) of duration of drug withdrawal,ratio of CD 19~+to CD45~+cells,and their combined detection for predicting SROT achievement in CITP patients treated with hetrombopag were 0.708,0.750,and 0.825,respectively.The AUC of combined detection was significantly higher than that of individual detection(P <0.05).Conclusion:Duration of drug withdrawal is a protective factor for achieving SROT in CITP patients receiving hetrombopag,while the ratio of CD 19~+to CD45~+cells is a risk factor.Combined detection of drug withdrawal duration and pre-treatment ratio of CD 19~+to CD45~+cells has high predictive value for identifying whether CITP patients can achieve SROT after hetrombopag treatment.更多还原