目的 探討甘露聚糖肽口服液聯(lián)合人免疫球蛋白治療特發(fā)性血小板減少性紫癜的臨床療效。方法 選取2014年8月-2015年8月在上海市浦東醫(yī)院接受治療的特發(fā)性血小板減少性紫癜患者74例,隨機(jī)分為對(duì)照組和治療組,每組各37例。對(duì)照組iv靜注人免疫球蛋白(pH 4),0.4 g/kg,1次/d。治療組在對(duì)照基礎(chǔ)上口服甘露聚糖肽口服液,1支/次,3次/d。兩組患者均治療4周。觀察兩組的臨床療效,比較治療前后兩組T淋巴細(xì)胞亞群、血小板相關(guān)抗體、血小板計(jì)數(shù)(PLT)、白細(xì)胞介素-4(IL-4)、止血時(shí)間和血小板數(shù)量達(dá)正常時(shí)間的情況。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為78.38%、94.59%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者CD³⁺和CD⁴⁺的水平及CD⁴⁺/CD⁸⁺的比值均顯著升高,而CD⁸⁺的水平顯著下降,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者血小板相關(guān)免疫球蛋白G(PA IgG)、血小板相關(guān)免疫球蛋白A(PA IgA)和血小板相關(guān)免疫球蛋白M(PA IgM)的水平均明顯降低,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者PLT及IL-4水平均明顯升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,治療組止血時(shí)間和血小板數(shù)量達(dá)正常時(shí)間均早于對(duì)照組,兩組比較差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 甘露聚糖肽口服液聯(lián)合人免疫球蛋白治療特發(fā)性血小板減少性紫癜具有較好的臨床療效,可提高患者機(jī)體免疫功能,加快止血,具有一定的臨床推廣應(yīng)用價(jià)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.