Clinical Efficacy Of Recombinant Human Thrombopoietin Combined With Intravenous Gamma Globulin In The Treatment Of Immune Thrombocytopenia In Children

Objective:To investigate the clinical efficacy of recombinant human thrombopoietin combined with intravenous gamma globulin in the treatment of children with immune thrombocytopenia(ITP).Methods:From September 2017 to August 2019,80 children with ITP with platelet decline greater than or equal to 2 times were selected for retrospective analysis.The subjects were recruited from the pediatric hematology ward of Shengjing Hospital affiliated to China Medical University and Shenyang Children’s Hospital.Groups were screened by different treatment methods during hospitalization,each of the two groups40 children,the observation group was given recombinant human thrombogenietin combined with intravenous injection of gamma globulin and the control group was given routine treatment with single intravenous injection of gamma globulin.The two groups of children were compared as follows:(1)Clinical features;(2)Therapeutic effect;(3)PLT count changes during treatment;(4)Changes in T lymphocyte expression;(5)The changes of B lymphocyte expression;(6)The occurrence of adverse reactions;(7)Treatment costs.The expression of T and B lymphocytes and their subsets were detected by flow cytometry.Results:The platelet rise,time to reach normal levels and bleeding control time in the observation group were significantly lower than in the control group(P<0.05);Among the 40 children in the observation group after 14 days of treatment,40 patients invalid for5 cases,total efficiency accounted for 87.50%compared with 40 control children,invalid for 12 cases,total efficiency accounted for 70.00%,the two groups varied significantly(P<0.05);After 3 months of treatment,36 of the 40 children in the observation group were effectively effective,invalid 4 cases the total efficiency was 90.00%,29 were effective compared with 40 children in the control group,invalid for 11 cases,total valid72.50%,differdifference were significant(P<0.05);Before treatment,there was no significant difference in platelet levels between the two groups(P>0.05).After treatment,platelet levels in the two groups were significantly increased,and the observation group was significantly higher than the control group(P<0.05).There were no significant differences in the expression rates of CD3~+,CD4~+,CD8~+,CD19~+and CD4~+/CD8~+between the observation group and the control group before treatment(P>0.05).After treatment,the expression rates of CD3~+,CD4~+and the ratio of CD4~+/CD8~+were significantly increased(P<0.05).The increased level of observation group was significantly higher than that of control group(P<0.05).The expression rates of CD8~+and CD19~+in 2 groups were significantly decreased(P<0.05),and the decrease rate in observation group was significantly higher than that in control group(P<0.05).Both groups had only mild and tolerated,transient adverse reactions,4 out of the 40 children in the observation group had adverse reactions,the incidence of adverse reactions was10.0%,3 out of the 40 children in the control group had adverse reactions,the incidence of adverse reactions was 7.50%,(P>0.05),no statistical significance;Treatment costs were significantly higher in the observation group than in the control group(P<0.05).Conclusion:The treatment of recombinant human thrombopoietin combined with IVIG in children with ITP can significantly enhance the treatment effect,which can tolerate and have no serious adverse reactions.Although the treatment cost is high,the plan can effectively reduce the probability of recurrence,and the overall cost may be less.This regimen may have better longer-term efficacy than IVIG alone and serves as a clinically recommended treatment regimen.