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目的探讨环孢素A辅助治疗难治性免疫性血小板减少性紫癜(ITP)的临床疗效及对患者血小板计数和细胞因子的影响。方法选择2013年1月至2016年12月期间浙江省金华市人民医院收治的难治性ITP患者78例。按照随机数字表分为观察组39例与对照组39例。对照组患者给予利妥昔单抗治疗,观察组在对照组基础上结合环孢素A辅助治疗,两组患者疗程均为3个月。比较两组患者的疗效,治疗前后血小板计数变化,血小板恢复正常时间,治疗前后细胞因子变化及不良反应发生情况。结果观察组患者治疗总有效率(92.31%)高于对照组(69.23%),差异有统计学意义(χ2=6.6857,P<0.05);两组患者治疗后血小板计数增加,观察组患者治疗后血小板计数高于对照组、血小板恢复正常时间低于对照组,差异均有统计学意义(t=20.6717、8.1189,P<0.05);两组患者治疗后IFN-γ水平较治疗前降低,IL-4、IL-10水平升高,差异有统计学意义(观察组:t=22.9522、11.7500、11.9032,对照组:t=9.8537、7.2250、6.7012,P<0.05),且治疗后观察组患者IFN-γ水平低于对照组,IL-4、IL-10水平高于对照组,差异有统计学意义(t=13.0096、3.8277、4.7989,P<0.05);两组患者不良反应发生率比较差异无统计学意义(χ2=0.0000,P>0.05)。结论环孢素A辅助治疗难治性ITP患者疗效显著,且可增加患者血小板数量,降低IFN-γ水平,增加IL-4、IL-10水平,提高患者免疫力。
Objective To investigate the clinical efficacy of cyclosporine A in the treatment of refractory immune thrombocytopenic purpura (ITP) and its effect on platelet count and cytokines. Methods 78 patients with refractory ITP admitted to Jinhua People’s Hospital of Zhejiang Province from January 2013 to December 2016 were selected. According to random number table divided into observation group 39 cases and control group 39 cases. Patients in the control group were treated with rituximab. The observation group was treated with cyclosporin A adjuvant therapy on the basis of the control group. Both groups were treated for 3 months. The curative effect, the change of platelet count before and after treatment, the normal time of platelet recovery, the change of cytokines before and after treatment and the incidence of adverse reactions were compared between the two groups. Results The total effective rate (92.31%) in the observation group was higher than that in the control group (69.23%), the difference was statistically significant (χ2 = 6.6857, P <0.05). The platelet count increased after treatment in both groups. (T = 20.6717, 8.1189, P <0.05). The levels of IFN-γ in both groups were lower than those before treatment, and the levels of IL- 4, the level of IL-10 increased, the difference was statistically significant (observation group: t = 22.9522,11.7500,11.9032, control group: t = 9.8537,7.2250,6.7012, P <0.05) The levels of IL-4 and IL-10 in the two groups were significantly higher than those in the control group (t = 13.0096,3.8277,4.7989, P <0.05). There was no statistical difference in the incidence of adverse reactions between the two groups Significance (χ2 = 0.0000, P> 0.05). Conclusion Cyclosporine A adjuvant treatment of patients with refractory ITP significant effect, and can increase the number of patients with platelet, reduce the level of IFN-γ, increase IL-4, IL-10 levels and improve patient immunity.