Clinical study of recombinant human thrombopoietin in patients with sepsis-associated thrombocytopenia

doi:10.3877/cma.j.issn.1674-6880.2016.05.004

Abstract

Abstract:

Objective

To evaluate the efficacy of recombinant human thrombopoietin (rhTPO) in patients with severe sepsis and thrombocytopenia.

Methods

Sixty-six patients with severe sepsis and hrombocytopenia between October 2013 and September 2015 were divided into the experiment group (35 cases) and control group (31 cases). All patients received primary treatment and infection control. And patients in the experiment group received rhTPO 300 U·kg^-1·d^-1 by hypodermic injection, and withdraw when platelet count (PLT) ≥ 50 × 10⁹/L, and the course did not exceed 14 d. Levels of PLT, C-reactive protein and alanine aminotransferase (ALT) were detected before and after the treatment on 1, 2, 3, 5, 7, 9 ans 14 d. The platelet transfusion cases, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), the time of temperature dropped to normal, time of clinical symptom disappearance, pulmonary imaging recovery time, 28-day fatality rate and length of ICU stay were compared between the two groups. The adverse reactions were recorded, and the activated partial thromboplastin time, levels of ALT, C-reactive protein and total bilirubin were compared before and after treatment in the experiment group.

Results

The PLT only increased markedly on 3 and 5 d after treatment in the experiment group as compared with those in the control group [(56 ± 19) × 10⁹/L vs. (42 ± 18) × 10⁹/L, t = 3.112, P < 0.05; (67 ± 22) × 10⁹/L vs. (54 ± 21) × 10⁹/L, t = 2.520, P < 0.05]. The platelet transfusion rate in the experiment group was much lower than that in the control group (5/35 vs. 11/31, χ² = 4.022, P = 0.045). However, the APACHEⅡ scores (t = 0.692, P < 0.05), the time of temperature dropped to normal (t = 0.510, P < 0.05), time of clinical symptom disappearance (t = 0.262, P < 0.05), pulmonary imaging recovery time (t = 0.685, P < 0.05), 28-day fatality rate (χ² = 0.001, P < 0.05) and length of ICU stay (t = 0.637, P < 0.05) all showed no significant differences between the two groups after treatment. Meanwhile, there was no adverse reactions happened, and the activated partial thromboplastin time (t = 0.697, P < 0.05), levels of ALT (t = 0.478, P < 0.05), C-reactive protein (t = 0.110, P < 0.05) and total bilirubin (t = 1.634, P < 0.05) in the experiment group also showed no significant differences before and after the treatment.

Conclusions

The use of rhTPO combined with conventional treatment in patients with sepsis-associated thrombocytopenia is safe. It can significantly enhance the platelet count, reduce platelet transfusion and improve patient's prognosis.

Key words: Recombinant human thrombopoietin, Sepsis, Thrombocytopenia

Weifang Zhang, Junjun Fang, Guobin Wang, Junlan Ni, Hui Li, Shijin Gong, Yihua Yu, Kun Fang, Weifeng Shu, Kong Pan, Linling Han, Shusen Zheng. Clinical study of recombinant human thrombopoietin in patients with sepsis-associated thrombocytopenia[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(05): 300-308.

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URL: https://zhwzzyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6880.2016.05.004

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指标	组别	例数	治疗前	治疗后1 d	治疗后2 d	治疗后3 d
血小板计数(× 10⁹/L)	实验组	35	37 ± 8	40 ± 8	40 ± 7	56 ± 19^a
血小板计数(× 10⁹/L)	对照组	31	39 ± 10	39 ± 9	39 ± 8	42 ± 18
C反应蛋白(μmol/L)	实验组	35	77 ± 35	80 ± 37	75 ± 31	74 ± 37
C反应蛋白(μmol/L)	对照组	31	72 ± 38	78 ± 34	76 ± 35	72 ± 39
ALT(U/L)	实验组	35	39 ± 21	38 ± 15	49 ± 20	51 ± 31
ALT(U/L)	对照组	31	39 ± 24	39 ± 16	46 ± 18	49 ± 31
指标	组别	例数	治疗后5 d	治疗后7 d	治疗后9 d	治疗后14 d
血小板计数(× 10⁹/L)	实验组	35	67 ± 22^a	102 ± 48	124 ± 35	178 ± 47
血小板计数(× 10⁹/L)	对照组	31	54 ± 21	90 ± 45	109 ± 30	157 ± 49
C反应蛋白(μmol/L)	实验组	35	74 ± 40	70 ± 38	71 ± 46	76 ± 33
C反应蛋白(μmol/L)	对照组	31	70 ± 39	70 ± 39	70 ± 39	71 ± 34
ALT(U/L)	实验组	35	45 ± 27	33 ± 18	38 ± 28	37 ± 18
ALT(U/L)	对照组	31	45 ± 28	31 ± 17	39 ± 26	42 ± 22

指标	组别	例数	治疗前	治疗后1 d	治疗后2 d	治疗后3 d
血小板计数(× 10⁹/L)	实验组	35	37 ± 8	40 ± 8	40 ± 7	56 ± 19^a
血小板计数(× 10⁹/L)	对照组	31	39 ± 10	39 ± 9	39 ± 8	42 ± 18
C反应蛋白(μmol/L)	实验组	35	77 ± 35	80 ± 37	75 ± 31	74 ± 37
C反应蛋白(μmol/L)	对照组	31	72 ± 38	78 ± 34	76 ± 35	72 ± 39
ALT(U/L)	实验组	35	39 ± 21	38 ± 15	49 ± 20	51 ± 31
ALT(U/L)	对照组	31	39 ± 24	39 ± 16	46 ± 18	49 ± 31
指标	组别	例数	治疗后5 d	治疗后7 d	治疗后9 d	治疗后14 d
血小板计数(× 10⁹/L)	实验组	35	67 ± 22^a	102 ± 48	124 ± 35	178 ± 47
血小板计数(× 10⁹/L)	对照组	31	54 ± 21	90 ± 45	109 ± 30	157 ± 49
C反应蛋白(μmol/L)	实验组	35	74 ± 40	70 ± 38	71 ± 46	76 ± 33
C反应蛋白(μmol/L)	对照组	31	70 ± 39	70 ± 39	70 ± 39	71 ± 34
ALT(U/L)	实验组	35	45 ± 27	33 ± 18	38 ± 28	37 ± 18
ALT(U/L)	对照组	31	45 ± 28	31 ± 17	39 ± 26	42 ± 22

组别	例数	APACHEⅡ评分（分）	体温下降正常的时间(d)	临床症状消失时间(d)	肺部影像学恢复所需时间(d)
实验组	35	17 ± 3	4.4 ± 2.1	8±4	10 ± 3
对照组	31	17 ± 3	4.1 ± 2.3	8±5	10 ± 4
t值	?	0.692	0.510	0.262	0.685
P值	?	0.091	0.183	0.398	0.267

组别	例数	APACHEⅡ评分（分）	体温下降正常的时间(d)	临床症状消失时间(d)	肺部影像学恢复所需时间(d)
实验组	35	17 ± 3	4.4 ± 2.1	8±4	10 ± 3
对照组	31	17 ± 3	4.1 ± 2.3	8±5	10 ± 4
t值	?	0.692	0.510	0.262	0.685
P值	?	0.091	0.183	0.398	0.267

组别	例数	活化部分凝血活酶时间(s)	ALT(U/L)	C反应蛋白μmol/L）	总胆红素(μmol/L)
治疗前	35	39 ± 7	39 ± 21	77 ± 35	19 ± 8
治疗后	35	40 ± 8	37 ± 18	876 ± 33	22 ± 8
t值	?	0.697	0.478	0.110	1.634
P值	?	0.121	0.145	0.387	0.138

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