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临床输血与检验

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (1): 133-136.DOI: 10.3969/j.issn.1671-2587.2023.01.022

• 临床研究 • 上一篇    下一篇

沙利度胺联合二线方案治疗复发、难治性ITP患者的观察性研究*

葛洪峰, 李淑娥, 楚海亮, 杨世礼, 纪晓娟, 丰江舟, 张司琪, 邢明泉, 梁海   

  1. 236800 安徽医科大学附属亳州医院血液科（葛洪峰,李淑娥,楚海亮,杨世礼,纪晓娟,丰江舟,张司琪,邢明泉）; 药学部（梁海）
  • 收稿日期:2022-07-29 发布日期:2023-02-20
  • 作者简介:葛洪峰（1977-）,男,安徽亳州人,医学硕士,副主任医师,主要从事贫血及出凝血疾病的诊治研究,（E-mail）futuoku6434_36@163.com。
  • 基金资助:
    *本课题受安徽医科大学校科研基金立项（No. 2021xkj095）资助

Thalidomide Combined with Second-line Regimen in Relapsed or Refractory ITP：a Observation Study

GE Hong-Feng, LI Shu-e, CHU Hai-liang, et al   

  1. Department of Hematology, Bozhou Hospital Affiliated to Anhui Medical University,Bozhou 236800
  • Received:2022-07-29 Published:2023-02-20

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摘要： 目的 探讨沙利度胺联合二线方案治疗复发、难治性原发免疫性血小板减少症（ITP）患者的疗效及其对Th1/Th2细胞因子的影响。方法 于2016年1月~2021年3月,将亳州市人民医院收治的86例复发、难治性ITP患者随机分为观察和对照2组, 每组各43例患者。对照组给予地塞米松和利妥昔单抗治疗;观察组在对照组基础上给予沙利度胺口服。两组均于治疗12周评价疗效。比较治疗前与治疗12周出血评分、血小板计数（PLT）、Th1细胞因子[肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）和白介素-2（IL-2）]、Th2细胞因子[白介素-4（IL-4）和白介素-10（IL-10）]水平变化。结果 观察组治疗总有效率为93.02%,明显高于对照组（72.09%）（P<0.05）。治疗12周,两组出血评分均低于治疗前（P<0.05）,观察组出血评分明显低于对照组（P<0.001）;观察组PLT计数明显高于对照组（P<0.001）;两组血清TNF-α、IFN-γ和IL-2水平均明显低于治疗前（P<0.05）,观察组明显低于对照组（P<0.001）;血清IL-4和IL-10水平均明显高于治疗前（P<0.05）,观察组明显高于对照组（P<0.001）。结论 沙利度胺联合二线方案治疗复发难治性ITP患者临床疗效显著,且可调节Th1/Th2细胞因子水平。

关键词: 沙利度胺, 地塞米松, 利妥昔单抗, 复发、难治性原发免疫性血小板减少症, 疗效, Th1/Th2细胞因子

Abstract: Objective To investigate the efficacy of thalidomide combined with a second-line regimen in the treatment of patients with relapsed and refractory immune thrombocytopenic purpura (ITP) and its effect on Th1/Th2 cytokines. Methods From January 2016 to March 2021, 86 patients with relapsed and refractory ITP admitted to Bozhou people's Hospital were enrolled and randomly divided into observation group and control group, with 43 patients in each group. The control group was treated with dexamethasone and rituximab, and the observation group was given thalidomide orally on top of the control group regimen. The curative effect was evaluated at 12 weeks of treatment in both groups. The changes in bleeding score, platelet count (PLT), Th1 cytokine [tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and interleukin-2 (IL-2)] and Th2 cytokine [interleukin-4 (IL-4) and interleukin-10 (IL-10)] levels were compared before treatment and at 12 weeks of treatment. Results The total effective rate of treatment in the observation group was 93.02%, which was significantly higher than that in the control group (72.09%) (P<0.05). At 12 weeks of treatment, the bleeding scores of both groups were lower than before treatment (P<0.05), and the bleeding scores of the observation group were significantly lower than those of the control group (P<0.001); the PLT count of the observation group was significantly higher than that of the control group (P<0.001); the serum TNF-α, IFN-γ and IL-2 levels of both groups were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than that of the control group (P<0.001); serum IL-4 and IL-10 levels were significantly higher than before treatment (P<0.05), and the observation group was significantly higher than the control group (P<0.001). Conclusion Thalidomide combined with the second-line regimen has a significant clinical effect in the treatment of patients with relapsed and refractory ITP, which can regulate the levels of Th1/Th2 cytokines.

Key words: Thalidomide, Dexamethasone, Rituximab, Relapsed and refractory immune thrombocytopenic purpura, Curative effect, Th1/Th2 cytokine

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