| Objective:Comparison of short-term efficacy,safety and cost-effectiveness analysis of glucocorticoid single drug,glucocorticoid combined with intravenous gamma globulin（IVIG）and glucocorticoid combined with recombinant human thrombopoietin（rhTPO）in the treatment of severe primary immune thrombocytopenia（ITP）.It provides a basis for clinicians to choose more effective,safe and economically feasible individualized treatment in the treatment of severe ITP.Methods:A total of 92 patients with severe primary immune thrombocytopenia treated in the Department of Hematology,Taizhou people’s Hospital from January 1,2015 to August 31,2020 were retrospectively analyzed.According to the treatment regimen,the patients were divided into glucocorticoid monotherapy group,glucocorticoid combined with intravenous gamma globulin treatment group,glucocorticoid combined with recombinant human thrombopoietin treatment group.To analyze and compare the general clinical characteristics（age,sex,baseline platelet count,bleeding score,average length of stay）,short-term efficacy（total effective rate during hospitalization,complete response rate and total effective rate in different treatment periods,platelet growth on the third,fifth and seventh day after treatment,and the number of days used to raise the platelet count to 30,50,100）and the incidence of adverse reactions.And through the cost-effectiveness analysis to compare the economic effectiveness of the three groups.Results:（1）Among the 92 patients with severe ITP,31 patients were treated with glucocorticoid alone,including 12 males and 19 females.The median age of onset was 64 years old,the median platelet count was 3×109/L.The median bleeding score was 4,and the average hospital stay was 10.34 days.There were26 patients in glucocorticoid combined with intravenous gamma globulin group,including 9 males and 17 females.The median age of onset was 52 years old.The median platelet count at admission was 2.5×109/L,the median bleeding score was 3.5,and the average hospital stay was 8.77 days.There were 35patients in glucocorticoid combined with recombinant human thrombopoietin group,including 15 males and 20 females.The median age of onset was 67 years old,the median platelet count was 3×109/L at admission,the median bleeding score was 4,and the average hospital stay was 9.21 days.There was no significant difference in general clinical characteristics among the three groups（P>0.05）.（2）During hospitalization,the total effective rates of the three treatments were 77.42%（glucocorticoid group）,92.31%（glucocorticoid combined with intravenous gamma globulin group）and 85.71%（glucocorticoid combined with recombinant human thrombopoietin group）.There was no significant difference in the total effective rate among the three groups（P>0.05）.（3）In the comparison of the total effective rate of different treatment periods,the total effective rate of the glucocorticoid group on the third day of treatment was the lowest（22.58%）,which was significantly different from that of the other two groups（P<0.05）.（4）In the comparison of the increase of platelet,there was significant difference among the three groups on the 3rd day after treatment（P<0.05）.The increase of platelet in the combination group was higher than that in the glucocorticoid group（P<0.05）.The platelet increase was the highest in the glucocorticoid combined with intravenous gamma globulin group（P<0.05）,which was significantly higher than that in the other two groups（P<0.05）.On the 5th day after treatment,there was also significant difference among the three groups,in which the platelet increase in the combined group was higher than that in the glucocorticoid group（P<0.05）.There was no significant difference in platelet increase between the two different combination regimens（P>0.05）.On the 7th day after treatment,there was no significant difference in platelet increase among the three groups.（5）In the comparison of the days of promoting platelet to 30×109/L and50×109/L,there was significant difference among the three groups(H30=8.816P30=0.015 H50=14.402 P50=0.001).The time taken to reach the target platelet count in the combination group was shorter than that in the glucocorticoid group（P<0.05）,and there was no significant difference between the two different combination regimens（P>0.05）.（6）The incidence of adverse reactions in the three groups was 16.12%,11.54%and 11.42%respectively,and there was no significant difference among the three groups（P>0.05）.（7）Among the three different treatment schemes,when there was no significant difference in the total effective rate during hospitalization,the cost of glucocorticoid combined with intravenous gamma globulin group was significantly higher than that of glucocorticoid combined with recombinant human thrombopoietin group.Conclusion:1.High-dose dexamethasone alone,high-dose dexamethasone combined with intravenous gamma globulin and high-dose dexamethasone combined with recombinant human thrombopoietin are commonly used in the treatment of severe ITP.The three groups of regimens are effective for patients in the short term,and the curative effect of the combination group is better.2.There was no significant difference in the total effective rate among the three groups during hospitalization,and the cost of treatment in the glucocorticoid group was the lowest,but the total effective rate,the complete response rate,the extent of platelet increase and the reaction time to rapidly raise the platelet to a safe level（platelet count>30×109/L and 50×109/L）in the early stage of treatment were lower than those in the combination group,which was relatively high in patients with severe ITP.3.On the basis of glucocorticoid,the efficacy and safety of combined use of recombinant human platelet（rhTPO）is not inferior to that of intravenous gamma globulin（IVIg）.And compared with IVIg,rhTPO has the advantages of relatively low price,convenient use of drugs,not easy to occur drug shortage and so on.Thus it can be seen that glucocorticoid combined with rhTPO has the characteristics of high efficiency,safety,economy and convenience in the treatment of severe ITP,and may become a first-line choice for the treatment of patients with severe ITP in the future. |
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