目的 比较性研究重组人血小板生成素和免疫球蛋白治疗脓毒症相关性血小板减少症的临床疗效。方法 收集2012年1月—2014年3月天津市第一中心医院、天津市南开医院脓毒症合并血小板减少症患者67例,随机分为对照组(35例)和治疗组(32例)。治疗组在对症治疗的基础上sc重组人血小板生成素注射液300 U/kg,1次/d。对照组在对症治疗的基础上静脉点滴人免疫球蛋白400 mg/kg,1次/d。两组患者血小板计数恢复至100×10⁹/L时或血小板计数绝对值升高≥50×10⁹/L时即停用升血小板药。观察治疗前,治疗第1、2、3、5、7、9天两组患者血小板计数、Toll4受体(TLR4)、血小板第4因子(PF4)、内源性血小板生成素(TPO)的变化。随访28 d记录两组血液制品的使用情况。结果 自用药后第2天开始,两组患者血小板计数均进行性升高,同组治疗前后差异有统计学意义(P < 0.05);治疗组较对照组升高的幅度更大(P < 0.05)。从治疗第1天开始,两组TLR4、PF4均较治疗前显著降低(P < 0.05),TPO显著升高,自治疗第5天后对照组TLR4、PF4下降趋势明显高于治疗组(P < 0.05);自治疗第2天开始,治疗组TPO显著高于对照组(P < 0.05)。治疗组输注血小板、血浆、红细胞均低于对照组(P < 0.05)。结论 重组人血小板生成素和免疫球蛋白治疗脓毒症相关性血小板生成素均有临床疗效,但重组人血小板生成素能在较短时间内提升患者血小板计数从而降低了患者早期出血的风险。

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.

天津市卫生局科技基金资助项目(10KG104)