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重组人血小板生成素治疗25例儿童重型免疫性血小板减少症的临床分析

[Clinical analysis of recombinant humanized thrombopoietin for treating 25 children with severe immune thrombocytopenia].

作者信息

Zheng Jie, Ma Jing-Yao, Su Yan, Yang Jing, Zhang Rui-Dong, Zhou Xuan, Wu Run-Hui

机构信息

Hematology Oncology Center, Beijing Key Laboratory of Pediatric Hematology and Oncology; Key Laboratory of Major Diseases in Children, Ministry of Education; National Key Discipline of Pediatrics; Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.

Hematology Oncology Center, Beijing Key Laboratory of Pediatric Hematology and Oncology; Key Laboratory of Major Diseases in Children, Ministry of Education; National Key Discipline of Pediatrics; Beijing Children's Hospital, Capital Medical University, Beijing 100045, China. E-mail:

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2014 Apr;22(2):393-8. doi: 10.7534/j.issn.1009-2137.2014.02.023.

Abstract

This study was aimed to evaluate the efficacy and safety of recombinant humanized thrombopoietin (rhTPO) for treating children with severe immune thrombocytopenia (ITP). A total of 25 patients with severe ITP who accepted rhTPO treatment for 14 days between December, 2009 and November, 2012 in Beijing Children's Hospital was retrospectively analyzed. The results showed that the median platelet counts of all 25 patients increased from the lowest level 4.0×10(9)/L (0×10(9)/L-10×10(9)/L) to the highest level 71×10(9)/L (14×10(9)/L-439×10(9)/L) on median 11 days (range from 3 days to 15 days). After rhTPO discontinuation, the platelet counts of patients gradually decreased. Complete response rate was 44% (11/25), response rate was 32% (8/25), non-response rate was 24% (6/25) and total response rate was 76% (19/25). The platelet count in the patients who showed complete response to rhTPO therapy reached the highest 112×10(9)/L (43×10(9)/L-439×10(9)/L) on median 12 days(range from 7 days to 15 days). The patients showed response to rhTPO treatment on median 4 days (range from 1 days to 11 days). The platelet count decreased gradually after the discontinuation of rhTPO administration but still significantly higher on 28 days than the level before the treatment (P < 0.05). 12 patients who did not respond to γ-globulin before rhTPO treatment showed response to γ-globulin after the discontinuation of rhTPO therapy. 2 patients showed mild clinical adverse reaction. It is concluded that rhTPO is an effective and safe treatment method for children with severe ITP. It will help the patient smoothly through the dangerous period of severe bleeding, but the platelet count decreases gradually after rhTPO discontinuation. Maintenance treatment is needed to consolidate the curative efficacy.

摘要

本研究旨在评估重组人血小板生成素(rhTPO)治疗儿童重症免疫性血小板减少症(ITP)的疗效和安全性。回顾性分析了2009年12月至2012年11月期间在北京儿童医院接受rhTPO治疗14天的25例重症ITP患者。结果显示,25例患者的血小板计数中位数从最低水平4.0×10⁹/L(0×10⁹/L - 10×10⁹/L)在中位11天(范围3天至15天)时升至最高水平71×10⁹/L(14×10⁹/L - 439×10⁹/L)。停用rhTPO后,患者血小板计数逐渐下降。完全缓解率为44%(11/25),缓解率为32%(8/25),无反应率为24%(6/25),总缓解率为76%(19/25)。对rhTPO治疗显示完全缓解的患者血小板计数在中位12天(范围7天至15天)时达到最高112×10⁹/L(43×10⁹/L - 439×10⁹/L)。患者对rhTPO治疗的反应中位时间为4天(范围1天至11天)。停用rhTPO给药后血小板计数逐渐下降,但在28天时仍显著高于治疗前水平(P < 0.05)。12例在rhTPO治疗前对γ球蛋白无反应的患者在停用rhTPO治疗后对γ球蛋白有反应。2例出现轻度临床不良反应。结论是rhTPO是治疗儿童重症ITP的一种有效且安全的治疗方法。它有助于患者顺利度过严重出血的危险期,但停用rhTPO后血小板计数会逐渐下降。需要维持治疗以巩固疗效。

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