目的 探討海曲泊帕乙醇胺片對(duì)抗腫瘤治療后血小板減少癥患者血小板參數(shù)、T淋巴細(xì)胞亞群、出血風(fēng)險(xiǎn)、血小板生成素（TPO）、信號(hào)轉(zhuǎn)導(dǎo)和轉(zhuǎn)錄激活因子3 （STAT3）、絲裂原活化蛋白激酶（MAPK）的影響。方法 前瞻性選取2021年9月-2022年1月徐州大學(xué)附屬醫(yī)院腫瘤科及宿遷市鐘吾醫(yī)院腫瘤科收治的47例抗腫瘤治療后血小板減少癥患者為研究對(duì)象，隨機(jī)數(shù)字表法分為對(duì)照組（n=3）和試驗(yàn)組（n=4）。對(duì)照組患者給予常規(guī)治療藥物干預(yù)，以重組人血小板生成素注射液sc治療，給藥劑量為300 U·kg-1，每日1次，連續(xù)治療4周。試驗(yàn)組患者在對(duì)照組基礎(chǔ)上增加海曲泊帕乙醇胺片口服治療，推薦初始劑量為每次2.5 mg，每日1次，治療期間監(jiān)測患者的血小板計(jì)數(shù)，根據(jù)患者血小板計(jì)數(shù)情況進(jìn)行劑量調(diào)整，每日最高劑量不超過7.5 mg，連續(xù)治療4周。對(duì)兩組患者的血小板參數(shù)、免疫功能指標(biāo)、出血風(fēng)險(xiǎn)分級(jí)及血清TPO、STAT3、MAPK水平、安全性等觀察指標(biāo)進(jìn)行評(píng)估對(duì)比。結(jié)果 治療后兩組患者的血小板參數(shù)水平較治療前均有改善（P＜0.05），試驗(yàn)組患者的血小板計(jì)數(shù)（PLT）、血小板壓積（PCT）高于對(duì)照組，血小板分布寬度（PDW）、血小板平均體積（MPV）均低于對(duì)照組（P＜0.05）。治療后兩組患者的T淋巴細(xì)胞亞群水平較治療前均有顯著改善（P＜0.05），試驗(yàn)組CD3⁺、CD4⁺、CD4⁺/CD8⁺高于對(duì)照組，CD8⁺低于對(duì)照組（P＜0.05）。治療后試驗(yàn)組患者世界衛(wèi)生組織（WHO）出血分級(jí)評(píng)估中0級(jí)、1級(jí)患者比例高于對(duì)照組，2級(jí)、3級(jí)患者比例低于對(duì)照組（P＜0.05）。治療后兩組患者的血清學(xué)指標(biāo)較治療前均有顯著改善（P＜0.05），試驗(yàn)組患者血清TPO、STAT3、MAPK水平均高于對(duì)照組（P＜0.05）。治療期間試驗(yàn)組、對(duì)照組不良反應(yīng)發(fā)生率分別為20.83%、17.39%，組間差異不顯著（P＞0.05）。結(jié)論 海曲泊帕乙醇胺片對(duì)抗腫瘤治療后血小板減少癥患者有良好的治療效果，可增加患者的血小板計(jì)數(shù)，提高患者的免疫功能，降低患者的出血風(fēng)險(xiǎn)，治療安全性較好，該藥發(fā)揮作用可能與升高TPO、STAT3、MAPK表達(dá)水平有關(guān)。

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

徐州市醫(yī)學(xué)科技創(chuàng)新立項(xiàng)項(xiàng)目（205999906）