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目的系统评价药物治疗造血干细胞移植后免疫性血小板减少症的临床疗效以及安全性。方法计算机检索PUBMED(1950~2016)、COCHRAN E CENTRAL(2016年第6期)、CBM(1979~2016)、CNKI(1976~2016)、VIP(1989~2016),按纳入排除标准筛选文献,描述性分析药物治疗造血干细胞移植后免疫性血小板减少症的临床疗效以及安全性。结果共纳入18个研究,均为病例报告。这些研究中涉及患者年龄从8个月到68岁不等,共有儿童患者13例,成人患者31例,患者年龄未知1例。45名患者均进行了造血干细胞移植,包括自体造血干细胞移植和异体造血干细胞移植。但在移植0.13~68.80个月后他们均出现了不同程度的难治性免疫性血小板减少症在治疗移植后免疫性血小板减少症时,患者使用IVIG时,总缓解率为31.30%(5/16例),激素类药物的缓解率为21.30%(5/23例),利妥昔单抗的缓解率为50.00%(8/16例),罗米司亭的缓解率为88.23%(15/17例),间充质干细胞(MSC)疗法的缓解率为100%(3/3例),长春新碱的缓解率为100%(1/1例),环孢素A的缓解率为0(0/1例),艾曲波帕的缓解率为100%(1/1例)。结论在治疗移植后血小板减少症时可以首先考虑一线治疗,即IVIG和激素类药物。如果一线药物效果不理想,则可选择罗米司亭和利妥昔单抗。如果仍不理想,可选用MSC疗法、长春新碱及艾曲波帕。
Objective To evaluate the clinical efficacy and safety of drug therapy for immune thrombocytopenia after hematopoietic stem cell transplantation. Methods The data of PUBMED (1950 ~ 2016), COCHRAN E CENTRAL (2016 6), CBM (1979 ~ 2016), CNKI (1976 ~ 2016) and VIP To analyze the clinical efficacy and safety of drug therapy for immune thrombocytopenia after hematopoietic stem cell transplantation. Results A total of 18 studies were included, all of which were case reports. Patients involved in these studies ranged in age from 8 months to 68 years, with a total of 13 children, 31 adults and 1 age unknown. All 45 patients underwent hematopoietic stem cell transplantation, including autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation. However, all of them had varying degrees of refractory immune thrombocytopenia after transplantation from 0.13 to 68.80 months. When using IVIG, the overall remission rate was 31.30% (5/16 The response rate of hormone therapy was 21.30% (5/23 cases), the response rate of rituximab was 50.00% (8/16 cases), and the response rate of romelystine was 88.23% (15 / 17). The remission rate of mesenchymal stem cells (MSC) was 100% (3/3), the rate of vincristine was 100% (1/1), and the remission rate of cyclosporin A was 0 (0/1 cases), the response rate of eltrombopag was 100% (1/1). Conclusions First-line treatment, IVIG and hormone drugs, may be the first consideration in the treatment of post-transplant thrombocytopenia. If first-line drugs do not work well, you can choose the combination of nomeytirizine and rituximab. If still not ideal, choose MSC therapy, vincristine and elquimborp.