目的 探讨甘露聚糖肽口服液联合人免疫球蛋白治疗特发性血小板减少性紫癜的临床疗效。方法 选取2014年8月-2015年8月在上海市浦东医院接受治疗的特发性血小板减少性紫癜患者74例,随机分为对照组和治疗组,每组各37例。对照组iv静注人免疫球蛋白(pH 4),0.4 g/kg,1次/d。治疗组在对照基础上口服甘露聚糖肽口服液,1支/次,3次/d。两组患者均治疗4周。观察两组的临床疗效,比较治疗前后两组T淋巴细胞亚群、血小板相关抗体、血小板计数(PLT)、白细胞介素-4(IL-4)、止血时间和血小板数量达正常时间的情况。结果 治疗后,对照组和治疗组的总有效率分别为78.38%、94.59%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者CD³⁺和CD⁴⁺的水平及CD⁴⁺/CD⁸⁺的比值均显著升高,而CD⁸⁺的水平显著下降,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血小板相关免疫球蛋白G(PA IgG)、血小板相关免疫球蛋白A(PA IgA)和血小板相关免疫球蛋白M(PA IgM)的水平均明显降低,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者PLT及IL-4水平均明显升高,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组止血时间和血小板数量达正常时间均早于对照组,两组比较差异均具有统计学意义(P<0.05)。结论 甘露聚糖肽口服液联合人免疫球蛋白治疗特发性血小板减少性紫癜具有较好的临床疗效,可提高患者机体免疫功能,加快止血,具有一定的临床推广应用价值。

Objective To analyze the use of antibiotics in Nanjing Maternity and Child Health Care Hospital, and to provide basis for reasonable application of antibiotics. Methods Antibacterial prescriptions (15 910 pieces) in Department of Outpatient in Nanjing Maternity and Child Health Care Hospital from January 2012 to December 2015 were randomly selected. Combination, route of administration, frequency of drug use (DDDs), and drug utilization index (DUI) were analyzed statistically. Results There were 15 910 pieces of antibacterial prescriptions from Department of Outpatient, accounting for 14.36% in total prescriptions of outpatients. There were 30 kinds of antibiotics, in which 13 555 pieces (85.20%) only used one kinds of antibiotics, and rates of double-drug and triple-drug were 12.90% and 1.90%, respectively. The most use of antibacterial prescriptions was cephalosporins, macrolides, and penicillins. The main administration route was oral administration, accounting for 79.82%. DDDs of Levofloxacin Hydrochloride Injection were higher, while DDDs of Cephathiamidine for injection and Cefoxitin Sodium for injection were lower. DUI of Roxithromycin Dispersible Tablets and Cefaclor Dispersible Tablets were more than 1.0. The unreasonable rate of antibiotics was 4.64%. The main types of unreasonable medicine were unclear indications, improper dosage and administration, and inappropriate choice of medicine. Conclusion Usage of antibiotics is higher in Nanjing Maternity and Child Health Care Hospital, therefore it should be taken standardized use of antibiotics to reduce the intensity use of antimicrobial drugs, and to avoid unreasonable application to ensure safe and effective medication.