重组人血小板生成素治疗老年滑膜肉瘤患者化疗后血小板下降的疗效观察

Efficacy of recombinant human thrombopoietin in treatment of chemotherapy induced thrombocytopenia in the elderly with synovial sarcoma

摘要:

目的 探究重组人血小板生成素治疗老年滑膜肉瘤患者化疗中发生的血小板下降的疗效，为临床用药提供指导。方法 选择解放军总医院骨科2011年4月至2015年6月收治的滑膜肉瘤老年患者60例，全部采用MAID化疗方案，随机分为两组，A、B两组患者分别在第二化疗周期和第一化疗周期化疗给药结束后24 h内应用重组人血小板生成素注射液（15000 U，1次/d，持续7 d或外周静脉血小板计数≥100×109/L时停药）。两组患者两次化疗间隔为14～21 d，血象复查全部指标在正常范围内后开始第二周期化疗，当患者血小板计数≤25×109/L时输注机采血小板。两组患者化疗期间其他辅助用药全部相同。观察患者化疗后外周血血小板最低值、恢复到的最高值、恢复至100×109/L所用时间、血小板≤50×109/L的持续时间，输注机采血小板的人次及数量。结果 （1） 两组患者在一般情况方面差异无统计学意义（P>0.05）。（2）在相同化疗周期内用药组与对照组比较，血小板最低值有明显提升（P<0.05），血小板最高值无明显差异（P>0.05），而恢复时间、血小板≤50×109/L的持续时间、输注血小板人次及数量明显下降，差异有统计学意义（P<0.05）。（3）两组患者自身的用药周期与对照周期相比，血小板最低值有明显提升（P<0.05），血小板最高值无明显差异（P>0.05），而恢复时间、血小板≤50×109/L的持续时间、输注血小板人次及数量明显下降，差异有统计学意义（P<0.05）。结论 重组人血小板生成素可有效提升老年滑膜肉瘤患者化疗后的外周血血小板数量，使患者能够接受最优剂量化疗，保证化疗效果，且其不良反应较少，安全性好，适宜在临床推广应用。

Abstract:

Objective To determine the efficacy of recombinant human thrombopoietin in the treatment of thrombocytopenia in the elderly patients with synovial sarcoma after chemotherapy. Methods Sixty elder patients with pathologically verified synovial sarcoma admitted in our Orthopedic Department during April 2011 and June 2015 were enrolled in this study. They were randomized into Group A and Group B, and were all treated with MAID chemotherapy (mesna, doxorubicin, ifosfamide, and dacarbazine). The patients from Group A did not receive recombinant human thrombopoietin in the first cycle of chemotherapy, but received within 24 h after the end of second cycle, at the dose of 15000U/d for 7 consecutive days or till the peripheral platelet count ≥100×109/L. For the patients of Group B, the protocol of thrombopoietin treatment was opposite to that of Group A. The interval of 2 cycles of chemotherapy was 14-21 d. The second cycle of thermotherapy started only when all the blood indicators were in the normal ranges. The patients were given platelet transfusion when the blood platelet count ≤25×109/L. Other adjuvant treatments were consistent between the groups. Minimal platelet count, recovery maximal platelet count, recovery time, duration to platelet count≤50×109/L, platelet transfusion times and units were recorded to evaluate the efficacy. Results (1) No significant differences were observed in baseline data between the 2 groups (P>0.05). (2) Minimal platelet counts were elevated (P<0.05), but maximal platelet counts remained unchanged in the thrombopoietin treatment group during both chemotherapy cycles (P>0.05). Recovery time, duration to platelet count≤50×109/L, and platelet transfusion times and units were decreased significantly in the treatment group than in the control group (P<0.05). (3) Minimal platelet counts were increased (P<0.05) and maximal platelet counts remained the same in the treatment cycle of both groups (P>0.05). Recovery time, duration to platelet counts ≤50×109/L, and platelet transfusion times and units were reduced remarkably in the treatment cycle than the un-treatment cycle in both groups (P<0.05). Conclusion Recombinant human thrombopoietin effectively promotes the platelet counts in the elder synovial sarcoma patients after chemotherapy, and improves the patients to accept optimal doses of chemotherapeutic drugs for better overall efficacy. It is safe and of few side effects, and thus worth of extensive clinical application.