CAJ | 학술논문

目的探讨降低预防性血小板输注剂量对慢性血小板减少症(chronic thrombocytopenia)患者出血的影响.方法选择2008年10月至2010年12月在本院住院的80例因造血干细胞移植(hematopoietic stem cell transplantation,HSCT)、血液系统肿瘤和实体瘤化疗引起的慢性血小板减少症患者(血小板计数<10×109/L)为研究对象.其中位年龄为45岁[(32～68)岁].将其按照预防性血小板输注接受剂量不同,分为低剂量组[1.1×1011/m2(体表面积)](n=40)和标准剂量组[2.2×1011/m2(体表面积)](n=40),每天检测记录疗效.根据WHO关于出血的四级分级标准,记录并分析超过二级的出血情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书).两组患者年龄、性别和其他内科疾病史等比较,差异无显著意义(P>0.05).结果在80例接受至少1次预防性血小板输注的血小板减少症住院患者中,WHO关于出血分级超过二级别的出血人数在低剂量组和标准剂量组分别为60.0%和62.5%,两组比较,差异无显著意义(P>0.05);WHO关于出血分级为三、四级的输注不良反应率在低剂量组和标准剂量组间比较,差异无显著意义(P>0.05).低剂量组患者与标准剂量组比较,在整个病期内所输注血小板总量显著降低[(7.92±1.49)×1011/m2(体表面积)vs.(12.06±1.79)× 1011/m2(体表面积)],差异有显著意义(P<0.05);平均血小板输注次数降低[(5.8±1.2)次vs.(4.3±1.0)次],差异有显著意义(P<0.05).结论降低预防性血小板输注剂量,对慢性血小板减少症患者的输血后出血风险无显著影响,并可使血小板输注总量显著降低.
목적 탐토강저예방성혈소판수주제량대만성혈소판감소증(chronic thrombocytopenia)환자출혈적영향.방법 선택2008년10월지2010년12월재본원주원적80례인조혈간세포이식(hematopoietic stem cell transplantation,HSCT)、혈액계통종류화실체류화료인기적만성혈소판감소증환자(혈소판계수<10×109/L)위연구대상.기중위년령위45세[(32～68)세].장기안조예방성혈소판수주접수제량불동,분위저제량조[1.1×1011/m2(체표면적)](n=40)화표준제량조[2.2×1011/m2(체표면적)](n=40),매천검측기록료효.근거WHO관우출혈적사급분급표준,기록병분석초과이급적출혈정황(본연구준순적정서부합본원인체시험위원회소제정적윤리학표준,득도해위원회비준,분조정득수시대상본인적지정동의,병여지첨서림상연구지정동의서).량조환자년령、성별화기타내과질병사등비교,차이무현저의의(P>0.05).결과 재80례접수지소1차예방성혈소판수주적혈소판감소증주원환자중,WHO관우출혈분급초과이급별적출혈인수재저제량조화표준제량조분별위60.0%화62.5%,량조비교,차이무현저의의(P>0.05);WHO관우출혈분급위삼、사급적수주불량반응솔재저제량조화표준제량조간비교,차이무현저의의(P>0.05).저제량조환자여표준제량조비교,재정개병기내소수주혈소판총량현저강저[(7.92±1.49)×1011/m2(체표면적)vs.(12.06±1.79)× 1011/m2(체표면적)],차이유현저의의(P<0.05);평균혈소판수주차수강저[(5.8±1.2)차vs.(4.3±1.0)차],차이유현저의의(P<0.05).결론 강저예방성혈소판수주제량,대만성혈소판감소증환자적수혈후출혈풍험무현저영향,병가사혈소판수주총량현저강저.
Objective To investigate the effect of reducing prophylactic platelet transfusion dose on bleeding in patients with hypoproliferative thrombocytopenia.Methods From October 2008 to December 2010,we randomly assigned 80 cases hospitalized patients undergoing hematopoietic stem-cell transplantation(HSCT) or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions.According to dosage of platelet transfusion divided them into low dose group[at a low dose of 1.1 × 1011/m2 (body-surface area),n = 40] and standard dose group[at a standard dose of 2.2× 1011/m2(body-surface area),n=40].Clinical signs of bleeding were assessed daily.The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria).There was no significance of age,sexuality and others diseases between two groups.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Zhongshan Hospital of Dalian University.Informed consent was obtained from all participants.Results In the 80 patients who received at least one platelet transfusion,the primary end points were observed in 60.0% and 62.5% of the patients in the low-dose group and the standard-dose group.There was no significance(P>0.05),respectively.The incidences of higher grades of bleeding,and other adverse events were similar between two groups.The median number of platelets transfused was significantly lower in the low-dose group than in the standarddose group [(7.92± 1.49)× 1011 /m2 (body-surface area) vs.(12.06± 1.79) × 1011 /m2 (body-surface area);P<0.05].The median number of platelet transfusions given was significantly lower in the low-dose group than in the standard-dose group[(5.8±1.2) vs.(4.3±1.0);P<0.05].Conclusion Low dose of platelet administered as a prophylactic transfusion had no effect on the incidence of bleeding in stable thrombocytopenia patients,and led to a decreased number of platelet transfused per patient.