目的 對比分析重組人血小板生成素（rhTPO）、重組人白介素-11（rhIL-11）分別聯(lián)合常規(guī)劑量糖皮質(zhì)激素（地塞米松）治療免疫性血小板減少性紫癜（ITP）的臨床療效。方法 選擇安徽醫(yī)科大學(xué)附屬安慶第一人民醫(yī)院2021年12月—2024年5月收治的85例ITP患者為研究對象，按隨機(jī)數(shù)字表法分為rhTPO組（n＝42）與rhIL-11組（n＝43），rhTPO組給予rhTPO（15 000 U·d^-1） ＋地塞米松（10 mg·d^-1）； rhIL-11組給予rhIL-11（1200萬U·d^-1） ＋予地塞米松（10 mg·d^-1），均連續(xù)治療14 d，未達(dá)14 d但血小板已恢復(fù)正常則停用rhTPO或rhIL-11。觀察兩組療效、血小板計數(shù)、出血評分、Th1細(xì)胞因子［白細(xì)胞介素-2（IL-2）、γ干擾素（IFN-γ）、腫瘤壞死因子-α（TNF-α）］、Th2細(xì)胞因子（IL-4、IL-5、IL-10）、不良反應(yīng)。結(jié)果rhTPO組、rhIL-11組臨床有效率差異無統(tǒng)計學(xué)意義（P＞0.05）。與治療前比較，兩組治療后不同時間血小板計數(shù)均顯著升高（P＜0.05），且rhTPO組的患者治療后第4、7天的血小板計數(shù)均高于rhIL-11組（P＜0.05）。與治療前比較，兩組治療后1 d出血評分開始降低，治療后4、7 d兩組出血評分均顯著降低（P＜0.05），且rhTPO組的患者治療后第4、7天的出血評分也均低于rhIL-11組（P＜0.05、0.01）。兩組治療后的IL-2、IFN-γ、TNF-α水平較治療前均顯著降低（P＜0.05），IL-4、IL-5、IL-10水平均顯著升高（P＜0.05），但兩組間比較差異無統(tǒng)計學(xué)意義（P＞0.05）。rhTPO組不良反應(yīng)發(fā)生率低于rhIL-11組（P＜0.05）。結(jié)論 rhTPO聯(lián)合常規(guī)劑量糖皮質(zhì)激素、rhIL-11聯(lián)合常規(guī)劑量糖皮質(zhì)激素治療ITP的療效相當(dāng)，且均可調(diào)節(jié)Th1、Th2免疫平衡，但rhTPO聯(lián)合常規(guī)劑量糖皮質(zhì)激素治療時血小板恢復(fù)更快，不良反應(yīng)更少。

Objective To compare and analyze the clinical efficacy of recombinant human thrombopoietin (rhTPO) and recombinant human interleukin-11 (rhIL-11) combined with conventional-dose glucocorticoid in the treatment of immune thrombocytopenic purpura (ITP). Methods A total of 85 patients with ITP in Anqing First People's Hospital Affiliated to Anhui Medical University from December 2021 to May 2024 were selected as the research subjects. According to the random number table method, they were divided into rhTPO group (n = 42) and rhIL-11 group (n = 43). The rhTPO group was given rhTPO (15 000 U·d^-1) + dexamethasone (10 mg·d^-1), while the·rhIL-11 group was given rhIL-11 (12 million U·d^-1) + dexamethasone (10 mg·d^-1), and both groups were continuously treated for 14 days, and rhTPO or rhIL-11 was discontinued when the platelet returned to normal level within 14 days. The efficacy, platelet count, bleeding score, Th1 cytokines (IL-2, IFN-γ, TNFα), Th2 cytokines (IL-4, IL-5, IL-10) and adverse reactions were observed in the two groups. Results There was no statistical significance in the clinical effective rate between rhTPO group and rhIL-11 group (P > 0.05). Compared with baseline, platelet counts in both groups significantly increased at all post-treatment time points (P < 0.05). Furthermore, platelet counts in the rhTPO group were significantly higher than those in the rhIL-11 group on posttreatment days 4 and 7 (P < 0.05). Compared with baseline, bleeding scores in both groups began to decrease on day 1 post-treatment, with significant reductions observed on days 4 and 7 (P < 0.05). Additionally, bleeding scores in the rhTPO group were significantly lower than those in the rhIL-11 group on post-treatment days 4 and 7 (P < 0.05, 0.01, respectively). After treatment, the levels of IL-2, IFN-γ and TNF-α in the two groups were decreased (P < 0.05); while the levels of IL-4, IL-5 and IL-10 were increased (P < 0.05), but there were no statistical differences between groups (P > 0.05). The incidence rates of adverse reactions in rhTPO group were lower than those in rhIL-11 group (P < 0.05). Conclusion The efficacy of rhTPO combined with conventional-dose glucocorticoid and rhIL- 11 combined with conventional-dose glucocorticoid in the treatment of ITP is comparable, and both drug regimens can regulate Th1 and Th2 immune balance, but rhTPO combined with conventional-dose glucocorticoid has faster platelet recovery and fewer adverse reactions.

R973

安徽省衛(wèi)生健康委科研項(xiàng)目立項(xiàng)項(xiàng)目（AHWJ2021b067）