目的 探讨腹腔镜下脾切除术（LS）治疗特发性血小板减少性紫癜(ITP)的临床效果。方法 我院2003年1月至2008年8月期间行LS治疗ITP患者20例，将术前与术后1、2、7、14、30、90及180 d的血小板计数进行比较。结果 20例ITP患者均顺利完成LS，平均手术时间为156 min，术中出血平均50 ml，平均住院时间为9 d。完全停用药物14例； 4例患者术后需继续服用激素治疗，但激素用量较前明显减少； 无效2例。总有效率为90%。术后1、2、7、14、30、90及180 d的血小板数量分别为(251.6±91.4)×109/L、(312.6±90.1)×109/L、(343.2±103.7)×109/L、(300.0±98.2)×109/L、(175.6±42.6)×109/L、(151.8±42.1)×109/L及(207.0±53.4)×109/L,分别与术前〔(38.3±19.4)×109/L〕比较，经t检验，差异均有统计学意义（P＜0.001）。结论 LS治疗ITP是可行和安全的，手术效果满意。
Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.
【摘要】 目的 评价重组人血小板生成素（rhTPO）治疗肿瘤化疗后血小板减少的疗效和安全性。 方法 2008年12月-2009年10月收住恶性肿瘤患者45例，在化疗后出现血小板减少，随机分为A、B组，A组皮下注射rhTPO（15 000 U/d），B组皮下注射白细胞介素-11（1.5 mg/d），动态监测注射后血小板生长情况。 结果 A组血小板计数的最低值明显高于B组（Plt;0.05）；A组血小板开始恢复时间较B组明显缩短（Plt;0.01）；血小板恢复至100×109/L以上所需时间A组较B组明显缩短（Plt;0.05），分别为（6.18±4.20）和（10.46±4.54） d，血小板恢复的最高值两组差异无统计学意义（Pgt;0.05）；B组有2例患者化疗后需要输入外源性血小板，A组无患者需要输入血小板；与B组比较，A组较少发生不良反应，患者可以耐受。 结论 重组人血小板生成素是一种治疗化疗后出现血小板减少的有效方法。【Abstract】 Objective To evaluate the therapeutic effect of recombinant human thrombopoietin (rhTPO) on chemotherapy-induced thrombocytopenia. Methods Forty-five in-patients with malignant tumor from December 2008 to October 2009 who had thrombocytopenia after chemotherapy were randomly divided into A and B groups. The patients in group A underwent the hypodermic injection with rhTPO (15 000 U/d) while in group B with interleukin-11 (1.5 mg/d);the platelet count was checked consecutively. Results Compared with that in group B, the platelet count was obviously higher (Plt;0.01) and the time of declined platelet count beginning to recover was significantly shorter in group A. The time of platelet count increasing to 100×109/L was within (6.18±4.20) days in group B which was significantly shorter than (10.46±4.54) days in group B (Plt;0.05). However, no significant was found between the two groups in the maximal platelet count (Pgt;0.05). Two patients needed platelet transfusion in group B and no one did in group A. Conclusion rhTPO is safe and effective for chemotherapy-induced thrombocytopenia.
Objective To investigate the expression and clinical significance of T lymphocyte subsets, natural killer (NK) cells and CD19+ B cells in the elderly with primary immune thrombocytopenia (ITP) before and after treatment. Methods The elderly ITP patients diagnosed and treated in the Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (preparatory stage) between January 2014 and June 2019 were retrospectively selected as the observation group. The healthy elderly in the same period were selected as the control group. According to the treatment, the observation group was divided into effective group and ineffective group. The expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells were observed and analyzed. Results A total of 75 subjects were included, including 35 in the observation group and 40 in the control group. The total effective rate was 85.71% (30/35). Before treatment, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were lower than those in the control group (P<0.05). There was no significant difference in other indexes between the two groups (P>0.05). After treatment, except for CD8+, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were higher than those before treatment (P<0.05). The expression levels of NK cells and CD19+ B cells were lower than those before treatment (P<0.05). The expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the effective group were higher than those before treatment (P<0.05), while the expression level of CD19+ B cells was lower than that before treatment (P<0.05). There was no significant difference in other indexes before and after treatment (P>0.05). There was no significant difference in the expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells in the ineffective group before and after treatment (P>0.05). Conclusions T lymphocyte subsets are abnormal in elderly ITP patients. The immune abnormality of T lymphocyte may be one of the reasons for elderly patients with ITP. With the improvement of therapeutic effect, immune cell subsets have also been improved.
ObjectiveTo systematically review the clinical effectiveness and safety of middle and low-dose gamma globulin for severe idiopathic thrombocytopenic purpurar (ITP). MethodsDatabases such as The Cochrane Library (Issue 2, 2013), PubMed, EMbase, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) involving the effectiveness and safety of middle and low-dose gamma globulin for severe ITP from the date of their establishment to July 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsEleven RCTs involving 548 patients were included. The trial group (n=272) were treated with middle and low dose of gamma globulin, while the control group (n=276) were treated with high dose of gamma globulin. The results of meta-analyses showed that there were no significant differences between the two groups in the total effective rate (RR=0.95, 95%CI 0.87 to 1.04, P=0.30), overall response rate (RR=0.97, 95%CI 0.85 to 1.10, P=0.60) and excellence rate (RR=0.94, 95%CI 0.78 to 1.14, P=0.54). The outcomes of time effect such as the time of platelet starting to rise and haemostasis time between the two groups was similar without significant differences. However, the control group was superior to the trial group in the peak time of platelet. The results of meta-analysis for platelet count of different periods showed that no significant differences were found in platelet count of 3, 7, and 14 days after starting the treatment, so do the peak of platelet count. No severe side effects were reported by both groups. ConclusionMiddle and low-dose gamma globulin could achieve the similar effect with the high-dose gamma globulin in the treatment of ITP. However, more high-quality, large-scale, RCTs are required to validate these results.
【摘要】 目的 探讨血栓性血小板减少性紫癜（thrombotic thrombocytopenic purpura，TTP）患者血管内皮损伤程度，以及不同类型TTP之间血管内皮损伤差异性。 方法 纳入2005年4月-2010年12月特发性TTP患者17例（A组），继发性TTP患者15例（B组），骨髓移植相关TTP患者2例（C组），疑似TTP患者11例（D组），共45例；另选取健康体检志愿者为对照组10例（E组）。采用双夹心酶联免疫吸附试验测定血管性血友病因子前肽（von Willebrand factor propeptide，vWFpp）水平。 结果 vWFpp水平为其与正常混合血浆的比值， A组为2.2，B组为2.34，C组为2.795，D组为1.72，E组为1.08。A、B、C、D组患者vWFpp水平与E组比较，差异有统计学意义（Plt;0.05），A、B、C、D组间比较，差异无统计学意义（Pgt;0.05）。 结论 TTP患者vWFpp水平明显增高，提示血管内皮损伤明显，但vWFpp水平不能用于鉴别TTP类型。【Abstract】 Objective To explore the severity of endothelium injury in patients with thrombotic thrombocytopenic purpura (TTP) and the differences among different subtypes of TTP. Methods The clinical data of 45 patients with TTP diagnosed between April 2005 and December 2010 were retrospectively analyzed. von Willebrand factor propeptide (vWFpp) was measured by sandwich ELISA in 17 patients with idiopathic TTP (group A), 15 patients with secondary TTP (group B), 2 patients with transplantation associated TTP (group C), 11 patients with suspected TTP (group D) and 10 control healthy volunteers (group E). Results Median times of vWFpp of the five groups were 2.2, 2.34, 2.795, 1.72, and 1.08 respectively. Plasma vWFpp levels of the first four groups didn′t differ much between each other (Plt;0.05), but the differences were significant compared with the data in the control group (Pgt;0.05). Conclusions Significantly increased vWFpp level in patients with TTP indicates obvious endothelium injury. Nevertheless, it could not be used to differentiate TTP types.