目的 研究血必净注射液联合重组人血小板生成素注射液治疗脓毒症相关性血小板减少症的临床疗效。方法 选取2017年12月-2019年12月在天津市中医药研究院附属医院治疗的70例脓毒症相关性血小板减少症患者，将所有患者随机分为对照组和治疗组，每组各35例。对照组静脉滴注重组人血小板生成素注射液，300 U/kg，1次/d，患者在用药过程中待血小板绝对值升高≥ 50×10⁹/L或血小板>100×10⁹/L即应停用。治疗组在对照组基础上静脉滴注血必净注射液，50 mL/次，2次/d。两组患者均持续治疗14 d。观察两组临床疗效，比较两组血小板水平动态变化、血清Toll4受体（TLR4）、血小板第4因子（PF4）和内源性血小板生成素（TPO）水平及血清血管性血友病因子（vWF）、肿瘤坏死因子-α（TNF-α）、可溶性CD40配体（sCD40L）水平。结果 治疗后，治疗组总有效率为94.29%，对照组总有效率为82.86%，治疗组总有效率显著高于对照组（P<0.05）。治疗3、5、7、10 d后，治疗组血小板水平均高于同期对照组（P<0.05）。治疗后，两组患者血清TLR4、PF4和TPO水平明显降低（P<0.05）；且治疗组血清TLR4、PF4和TPO水平降低较明显（P<0.05）。治疗后，两组血清vWF、TNF-α和sCD40L水平均显著降低（P<0.05）；并且治疗组患者血清vWF、TNF-α和sCD40L水平降低较明显（P<0.05）。结论 血必净注射液联合重组人血小板生成素注射液治疗脓毒症相关性血小板减少症具有较好的治疗效果，可降低血清TLR4、PF4、TPO水平和vWF、TNF-α和sCD40L水平。

Objective To study the efficacy of Xubijing Injection combined with Recombinant Human Thrombopoietin Injection in treatment of sepsis associated thrombocytopenia. Methods Patients (70 cases) with sepsis associated thrombocytopenia in the Affiliated Hospital of Tianjin Institute of Chinese Medicine from December 2017 to December 2019 were randomly divided into control and treatment groups, and each group had 35 cases. Patients in the control group were iv administered with Recombinant Human Thrombopoietin Injection, 300 U/kg, once daily, and patients should stop using the drug when the absolute value of platelets increased ≥ 50×10⁹/L, or platelets > 100×10⁹/L. Patients in the treatment group were iv administered with Xubijing Injection on the basis of the control group, 50 mL/time, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and the dynamic changes of platelet levels, the serum factors levels of TLR4, PF4, TPO, vWF, TNF-α, and sCD40L in two groups were compared. Results After treatment, the total effective rate of the treatment group was 94.29%, and that of the control group was 82.86%, and the total effective rate of the treatment group was significantly higher than that of the control group (P < 0.05). After treatment for 3, 5, 7, and 10 d, the platelet levels in the treatment group were higher than those in the control group at the same period (P < 0.05). After treatment, the serum levels of TLR4, PF4, and TPO in two groups were significantly decreased (P < 0.05), and the serum levels of TLR4, PF4, and TPO in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of vWF, TNF-α, and sCD40L in two groups were significantly decreased (P < 0.05), and the serum levels of vWF, TNF-α, and sCD40L in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Xubijing Injection combined with Recombinant Human Thrombopoietin Injection has clinical curative effect in treatment of sepsis associated thrombocytopenia, can reduce the serum levels of TLR4, PF4, TPO, vWF, TNF-α, and sCD40L in serum.

R973