目的 探讨海曲泊帕乙醇胺片对抗肿瘤治疗后血小板减少症患者血小板参数、T淋巴细胞亚群、出血风险、血小板生成素（TPO）、信号转导和转录激活因子3 （STAT3）、丝裂原活化蛋白激酶（MAPK）的影响。方法 前瞻性选取2021年9月-2022年1月徐州大学附属医院肿瘤科及宿迁市钟吾医院肿瘤科收治的47例抗肿瘤治疗后血小板减少症患者为研究对象，随机数字表法分为对照组（n=3）和试验组（n=4）。对照组患者给予常规治疗药物干预，以重组人血小板生成素注射液sc治疗，给药剂量为300 U·kg-1，每日1次，连续治疗4周。试验组患者在对照组基础上增加海曲泊帕乙醇胺片口服治疗，推荐初始剂量为每次2.5 mg，每日1次，治疗期间监测患者的血小板计数，根据患者血小板计数情况进行剂量调整，每日最高剂量不超过7.5 mg，连续治疗4周。对两组患者的血小板参数、免疫功能指标、出血风险分级及血清TPO、STAT3、MAPK水平、安全性等观察指标进行评估对比。结果 治疗后两组患者的血小板参数水平较治疗前均有改善（P＜0.05），试验组患者的血小板计数（PLT）、血小板压积（PCT）高于对照组，血小板分布宽度（PDW）、血小板平均体积（MPV）均低于对照组（P＜0.05）。治疗后两组患者的T淋巴细胞亚群水平较治疗前均有显著改善（P＜0.05），试验组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组，CD8⁺低于对照组（P＜0.05）。治疗后试验组患者世界卫生组织（WHO）出血分级评估中0级、1级患者比例高于对照组，2级、3级患者比例低于对照组（P＜0.05）。治疗后两组患者的血清学指标较治疗前均有显著改善（P＜0.05），试验组患者血清TPO、STAT3、MAPK水平均高于对照组（P＜0.05）。治疗期间试验组、对照组不良反应发生率分别为20.83%、17.39%，组间差异不显著（P＞0.05）。结论 海曲泊帕乙醇胺片对抗肿瘤治疗后血小板减少症患者有良好的治疗效果，可增加患者的血小板计数，提高患者的免疫功能，降低患者的出血风险，治疗安全性较好，该药发挥作用可能与升高TPO、STAT3、MAPK表达水平有关。

Objective To analyze the effects of Herombopag Olamine Tablets on platelet parameters, T lymphocyte subsets, bleeding risk, thrombopoietin (TPO), signal transducer and activator of transcription 3 (STAT3) and mitogen activated protein kinase (MAPK) in patients with thrombocytopenia after anti-tumor treatment. Methods A total of 47 patients with thrombocytopenia after anti-tumor treatment admitted to the Department of Oncology, Affiliated Hospital of Xuzhou University and the Department of Oncology, Zhongwu Hospital of Suqian City from September 2021 to January 2022 were selected as the study subjects. They were randomly divided into control group (n= 23) and experimental group (n= 24) by the method of random number table. The patients in the control group were treated with conventional treatment drugs and Recombinant Human Thrombopoietin Injection sc, with a dose of 300 U·kg^-1, once a day, for four weeks. The patients in the experimental group were given oral administration of Herombopag Olamine Tablets on the basis of the control group. The recommended initial dose was 2.5 mg each time, once a day. During the treatment, the platelet count of the patients was monitored, and the dose was adjusted according to the platelet count of the patients. The maximum daily dose was not more than 7.5 mg, and the treatment lasted for four weeks. The platelet parameters, immune function indexes, bleeding risk classification, serological marker levels of TPO, STAT3, MAPK, treatment safety and other observation indexes of the two groups were evaluated and compared. Results After treatment, the levels of platelet parameters in the two groups were improved compared with those before treatment (P< 0.05). The platelet count (PLT) and platelet hematocrit (PCT) in the experimental group were higher than those in the control group, and the platelet distribution width (PDW) and average platelet volume (MPV) were lower than those in the control group (P< 0.05). After treatment, the levels of T lymphocyte subsets in the two groups were significantly improved compared with those before treatment (P< 0.05). CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the experimental group were higher than those in the control group, and CD8⁺ was lower than those in the control group (P< 0.05). After treatment, the proportion of WHO bleeding grading assessment grade 0 and grade 1 patients in the experimental group was higher than that in the control group, and the proportion of WHO bleeding grading assessment grade 2 and grade 3 patients was lower than that in the control group (P< 0.05). After treatment, the serum indexes of the two groups were significantly improved compared with those before treatment (P< 0.05). The levels of TPO, STAT3 and MAPK in the experimental group were higher than those in the control group (P< 0.05). During the treatment, the incidence of adverse reactions in the experimental group and the control group was 20.83% and 17.39%, and there was no significant difference between two groups (P> 0.05). Conclusion Herombopag Olamine Tablets has good therapeutic effect on patients with thrombocytopenia after anti-tumor treatment. It can increase the platelet count, and it can improve the immune function, it can reduce the risk of bleeding, and it has good therapeutic safety. The effect of Herombopag Olamine Tablets may be related to the increase of the expression levels of TPO, STAT3 and MAPK.

R973

徐州市医学科技创新立项项目（205999906）