目的：探讨重组人血小板生成素联合重组人白细胞介素11治疗恶性肿瘤放化疗后血小板减小症的安全性及有效性。方法选取2011年12月至2014年12月南阳南石医院恶性肿瘤放化疗后血小板减小症患者132例，采用随机数字表法分为 A组、B 组、C 组，各44例。 A组采用重组人白细胞介素11治疗，加入到灭菌0．9％NaCl注射液1 mL，皮下注射1．5 mg／次；B组采用重组人血小板生成素治疗，皮下注射15000 U／次，每日1次；C组采用重组人血小板生成素联合重组人白细胞介素11治疗，重组人血小板生成素用法同B组，重组人白细胞介素11用法同A组。比较三组患者治疗前后血常规指标、凝血指标、肝肾指标，分析三组患者血小板计数恢复时间、治疗时间、血制品输注情况、临床疗效、药物不良反应。结果治疗后，三组患者白细胞计数、红细胞计数、血红蛋白、凝血酶原时间、部分活化凝血活酶时间、纤维蛋白原、凝血酶时间、天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素、白蛋白、肌酐较治疗前均无明显改变（P＞0．05）。治疗后C组血小板计数显著高于A组和B组[（118．9±13．4）×109／L比（89．1±10．3）×109／L，（101．2±16．2）×109／L ]，B组显著高于A组（P＜0．05）。 C组血小板计数＞100×109／L恢复时间短于A组和B组[（13．95±1．41） d比（20．38±1．62） d，（17．60±1．54） d]，B组短于A组（ P＜0．05）。 C 组 ICU 住院时间、持续用药时间短于 A 组和 B 组[（11．53±1．27） d 比（15．02±0．94） d，（13．68±1．59） d；（7．16±0．53） d比（10．34±1．05） d，（8．92±0．87） d]，B组短于A组（P＜0．05）；血浆、浓缩红细胞、血小板少于 A组和B 组[（136±41） mL比（294±76） mL，（223±54） mL；（1．12±0．47） U 比（2．76±0．51）U，（1．98±0．32） U；（0．83±0．21） U 比（2．14±0．67）U，（1．46±0．40） U]，B组少于A组（P＜0．05）。 C组治疗总有效率高于A组和B组（100．0％比75．0％，90．9％），B组高于A组（P＜0．05）。 A、B、C 组药物不良反应发生率差异无统计学意义[13．64％（6／44）比11．36％（5／44）比15．91％（7／44），P ＞0．05]。结论重组人血小板生成素、重组人白细胞介素11均是治疗恶性肿瘤放化疗后血小板减小症的有效药物，联合用药的效果更佳，安全性较高。%Objective To investigate efficacy and safety of recombinant human thrombopoietin combined with recombinant human interleukin-11 in treatment of thrombocytopenia after radiotherapy and chemotherapy for malignant tumor.Methods Total of 132 patients with thrombocytopenia after radiotherapy and chemotherapy for malignant tumor were selected in Nanyang Nanshi Hospital from Dec.2011 to Dec.2014,who were randomly divided into group A,B,C according to the random number table method,44 patients each.Group A was treated recombinant human interleukin-11, added to sterilizedn 0.9% NaCl injection 1 mL, subcutaneous injection 1.5 mg/time;group B was treated recombinant human thrombopoietin,subcutaneous injection 15 000 U/time, once per day;group C was treated recombinant human thrombopoietin(administered as group B) combined with recombinant human interleukin-11(administered as group A).The blood routine index,coagulation index,liver index before and after treatment were compared between the three groups.Platelet count recovery time,treatment time,blood products infusion,clinical efficacy,adverse drug reactions of the three groups were analyzed.Results After treatment,the white blood cell count,red blood cell count,hemoglobin,prothrombin time,activated par-tial thromboplastin time, fibrinogen, thrombin time, aspartate aminotransferase, alanine aminotransferase, total bilirubin,albumin,creatinine of the three groups were not changed significantly compared with before treatment (P>0.05).After treatment,platelet count of group C was significantly higher than group A,B [(118.9 ± 13.4) ×109/L vs (89.1 ±10.3) ×109/L,(101.8 ±16.3) ×109/L],group B was significantly higher than group A (P <0.05).Platelet count >100 ×109/L recovery time of group C were shorter than group A,B [(13.95 ±1.41) d vs (20.38 ±1.62) d,(17.60 ±1.54) d],group B was significantly shorter than group A (P<0.05).ICU stay time,continuous medication time of group C were shorter than group A,B[(11.53 ± 1.27) d vs (15.02 ±0.94) d, (13.68 ±1.59) d;(7.16 ±0.53) d vs (10.34 ±1.05) d, (8.92 ±0. 87) d],group B shorter than group A;plasma,concentrated red blood cells,platelets of group C were less than group A,B [(136 ±41) mL vs (294 ±76) mL,(223 ±54) mL;(1.12 ±0.47) U vs (2.76 ±0.51) U, (1.98 ±0.32) U;(0.83 ±0.21) U vs (2.14 ±0.67)U,(1.46 ±0.40) U],group B was significantly less than group A ( P <0.05 ) .Total effective rate of group C was higher than group A , B ( 100.0% vs 75.0%, 90.9%),group B was significantly higher than group A (P<0.05).There were not statistically significant in incidence of adverse drug reactions between group A,B,C[13.64%(6/44) vs 11.36%(5/44) vs 15.91%(7/44),P>0.05].Conclusion Recombinant human erythropoietin,recombinant human interleukin -11 are both effective drugs for treatment of thrombocytopenia after radiotherapy and chemotherapy for malignant tumor , and the combination treatment has better effect with high safety .
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