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目的探讨甘露聚糖肽口服液联合人免疫球蛋白治疗特发性血小板减少性紫癜的临床疗效。方法选取2014年8月—2015年8月在上海市浦东医院接受治疗的特发性血小板减少性紫癜患者74例,随机分为对照组和治疗组,每组各37例。对照组iv静注人免疫球蛋白(pH4),0.4 g/kg,1次/d。治疗组在对照基础上口服甘露聚糖肽口服液,1支/次,3次/d。两组患者均治疗4周。观察两组的临床疗效,比较治疗前后两组T淋巴细胞亚群、血小板相关抗体、血小板计数(PLT)、白细胞介素-4(IL-4)、止血时间和血小板数量达正常时间的情况。结果治疗后,对照组和治疗组的总有效率分别为78.38%、94.59%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者CD~(3+)和CD~(4+)的水平及CD~(4+)/CD~(8+)的比值均显著升高,而CD~(8+)的水平显著下降,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血小板相关免疫球蛋白G(PA IgG)、血小板相关免疫球蛋白A(PA IgA)和血小板相关免疫球蛋白M(PA IgM)的水平均明显降低,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者PLT及IL-4水平均明显升高,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组止血时间和血小板数量达正常时间均早于对照组,两组比较差异均具有统计学意义(P<0.05)。结论甘露聚糖肽口服液联合人免疫球蛋白治疗特发性血小板减少性紫癜具有较好的临床疗效,可提高患者机体免疫功能,加快止血,具有一定的临床推广应用价值。
Objective To investigate the clinical efficacy of Mannatide oral liquid combined with human immunoglobulin in the treatment of idiopathic thrombocytopenic purpura. Methods Totally 74 patients with idiopathic thrombocytopenic purpura who were treated in Shanghai Pudong Hospital from August 2014 to August 2015 were randomly divided into control group and treatment group, 37 cases in each group. Control group iv intravenous human immunoglobulin (pH4), 0.4 g / kg, 1 time / d. The treatment group on the basis of the control oral mannan glycopeptide oral solution, 1 / time, 3 times / d. Two groups of patients were treated for 4 weeks. The clinical efficacy of the two groups were observed. T lymphocyte subsets, platelet-related antibodies, platelet count (PLT), interleukin-4 (IL-4), bleeding time and platelet count were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the control group and the treatment group were 78.38% and 94.59% respectively, with significant difference between the two groups (P <0.05). After treatment, the levels of CD ~ (3+) and CD ~ (4+) and the ratio of CD ~ (4 +) / CD ~ (8+) were significantly increased in both groups, (P <0.05). The improvement of these indexes in the treatment group was better than that in the control group, the difference between the two groups was statistically significant (P <0.05). After treatment, the levels of platelet-associated immunoglobulin G (PA IgG), platelet-associated immunoglobulin A (PA IgA) and platelet-associated immunoglobulin M (PA IgM) were significantly decreased in both groups (P <0.05). The improvement of these indexes in the treatment group was better than that in the control group, the difference between the two groups was statistically significant (P <0.05). After treatment, the levels of PLT and IL-4 in both groups were significantly increased, the difference was statistically significant (P <0.05) between the two groups before and after treatment; and the improvement of the observation group in the treatment group was better than that in the control group Statistically significant (P <0.05). After treatment, the treatment group bleeding time and platelet number up to normal earlier than the control group, the difference between the two groups were statistically significant (P <0.05). Conclusion Mannatide oral liquid combined with human immunoglobulin in the treatment of idiopathic thrombocytopenic purpura has good clinical efficacy, can improve the immune function of patients and accelerate the bleeding, and has some clinical application value.