Clinical Study Of Recombinant Human Thrombopoietin In Thrombocytopenia Associated With Sepsis

ObjectiveThrombocytopenia(TCP)is one of the dangerous sign towards the patient with severe sepsis.Sepsis are independent risk factors for ICU patients with Thrombocytopenia.The decline number of platelet often prompt severe sepsis,and with serious prognosis.Recovery of the lowest number of platelet associated with reduced mortality.How to effectively improve sepsis-associated thrombocytopenia,has increasingly caught the attention of the clinicians.This test of patients of sepsis-associated thrombocytopenia on the basis of the comprehensive treatment such as infection control,adminstrated human recombinant human thrombopoietin(rhTPO)and immuneglobulin(IVIG).Observation rhTPO clinical efficacy and safety that provide new therapy and clinical evidence as to sepsis-related thrombocytopenia.MethodsThe observer can be divided into three groups:normal control group,rhTPO group,IVIG group.1.20 cases of normal control group:Respectively to extract its peripheral venous blood.Detected blood routine,blood biochemistry,DIC,thrombelastogram,R value(reaction time),K value(solidification time),MA(maximum amplitude of thrombus),CI value(Clotting index),a(solidification horn).Used immune enzyme-linked adsorption experiments,detected TLR4,PF4,TPO concentration.2.67 patients with sepsis-associated thrombocytopenia on the basis of gender,age,illness,platelet count four factors level,according to " principle of minimum distrbution imbalance index",divided into rhTPO group(32 cases),IVIG group(35 cases).Patients before medication,medication after the 1st,2nd,3rd,5th,7th,9th day,extract the peripheral venous blood were recorded each time point of blood routine,blood biochemistry,DIC,thrombelastogram,detection R value(reaction time),the K value(solidification time),MA(maximum amplitude of thrombus),a(solidification horn),CI value(Clotting index).Comparison of rhTPO group,IVIG group observer the dynamic changes of the platelet count;comparison of drug use in the process of minimum and maximum platelet;The time of durative thrombocytopenia;Platelet and other blood products transfusion;the influence of drugs on liver and kidney function,blood coagulation function,the influence of the red blood cells,white blood cells;Adverse drug reactions;ICU hospitalization days and fees,follow-up within 28 d case fatality rate.And ELISA text at different time points detecetd TLR4,PF4,TPO concentration and serum anti rhTPO antibody.Result1.Clinical efficiency:With observation medicine after 1st day,rhTPO group and IVIG group,the platelet count of all patients was increased,but the platelet count is similar between the two groups,and has no statistical significance(P>0.05).Since after the 2nd day,the increased extent of platelet,rhTPO group was obviously higher than that of IVIG group and the difference is statistically significant(P<0.05).After the 3rd,5th,7th,9th day,each group platelet count were progressive higher.Compared to IVIG group,rhTPO increase amplitude is bigger,with significant difference(P<0.05).The highest of Platelet count of rhTPO group was obviously higher than that of IVIG group and the difference has statistical significance(P<0.05).rhTPO platelet count in patients returned to 50×109/L and the platelet count returned to 100 X 109/L,rhTPO group significantly reduced(P<0.05).Platelet transfusion and other blood product quantity of rhTPO group were lower the IVIG group(P<0.05).Two groups of patients with ICU hospitalization days there was no statistically significant difference(P>0.05).The total cost of ICU in the hospital there was no statistically significant difference(P>0.05).but repectively costs of the text drug were statistically difference(P<0.05),rhTPO cost significantly lower than the IVIG cost(P<0.05).Followed up for 28 days,rhTPO mortality differences between group and IVIG group,and has no statistical significance(P>0.05).2.Clinical safty:After each time point in the two groups of drugs on the ALT,TBiL,Cr,ALB,RBC,WBC indicators no significant differences(P>0.05).Two groups of patients,PT,APTT,Fib,D-dimer values of each time points was not statistically difference(P>0.05).Thrombelastogram K value,R value,MA values,solidification horn,the CI value indicators no significant difference(P>0.05).Serum During the 1st,2nd,3rd day,the TLR4 serum concentrations of two groups of patients is no significant difference(P>0.05).After the 5th day,IVIG group of TLR4 concentration decreased and two group has significant difference(P<0.05).During the 7th,9th day,IVIG group concentration continue a downward trend.And two group with significant difference(P<0.05).During the 1st,2nd,3rd,5th day,PF4 serum concentration is no significant difference(P>0.05).After the 7th,9th day,IVIG group of patients serum concentrations had significant difference(P<0.05).Two groups of patients after the 2nd day,TPO concentration in serum,rhTPO group is significantly higher than IVIG group,and two groups with the statistically significant difference(P<0.05).rhTPO patients serum TLR4,PF4 compare concentration between each point,and two groups has no significant difference(P>0.05).Serum TPO concentration within the 1st,2nd,3rd,5th,7th day are statistically differences(P<0.05).Compare to the 9th day,concentration of TPO of the 1st,2nd,3rd,5th,7th day has no significant difference(P>0.05).The adverse reaction of two group was found in all 2-8 days.The anti rhTPO antibody in serum was not discovered.ConclusionBy sepsis-associated thrombocytopenia patients respectively used rhTPO and IVIG,experiment further confirmed:1.rhTPO in increasing platelet speeds and amplitude is obviously better than IVIG group.The the amount of blood transfusion therapies in the treatment process is less than the IVIG group,thereby reducing the side effects of blood product transfusion,improve the clinical curative effect.2.The patients of rhTPO group don't occurre adverse reaction,and don't impair the function of liver,kidney,blood coagulation.The concentration of serum inflammatory index does not appear the rising trend.the antibody of anti rhTPO cannot be found that make sure the safety of medication.