沈　澍

作者单位：江苏省溧阳市人民医院　药剂科　213300

环孢素A血药浓度对难治性免疫性血小板减少性紫癜疗效的影响

沈澍

作者单位：江苏省溧阳市人民医院药剂科213300

【摘要】目的探讨环孢素A(CsA)血药浓度对难治性免疫性血小板减少性紫癜(ITP)临床疗效的影响。方法采用CsA或联合糖皮质激素治疗难治性ITP患者，检测治疗后前3个月的CsA浓度和血小板计数(PLT)，分析CsA谷浓度(C0)和峰浓度(C2)对血小板的影响。结果治疗3个月后，12例患者中1例治疗无效，11例PLT上升，增加血药浓度或延长治疗时间可提高部分患者疗效。治疗1个月后，与未显效组比较，显效组中患者C0均>100μg/L，差异有统计学意义(P<0.05)；C2的变化无统计学意义(P>0.05)。治疗3个月后，与未显效组比较，C0、C2变化均无统计学意义(P>0.05)，即治疗3个月后CsA血药浓度与疗效无明显相关性。结论加用CsA可改善难治性ITP预后，维持C0正常范围可增加PLT并保持稳定。

【关键词】环孢素A免疫性血小板减少性紫癜血小板计数

doi:10.3969/j.issn.1672-4860.2015.06.023

【Abstract】ObjectivesTo analyze the efficacy of the plasma concentration of cyclosporine A (CsA) on immune thrombocytopenic purpura (ITP). MethodsPatients with refractory ITP were treated with CsA or/and glucocorticoid. CsA concentration and blood platelet count (BPC) were detected 1～3 months after treatment and the influence of the minimum concentration (C0) and peak concentration (C2) on blood platelet were analyzed. Results3 months later, one of 12 patients had no response to treatment and 11 patients had the elevated level of PLT. The increased blood concentration and prolonged treatment time improved the efficacy of patients. 1 months later, compared with the not markedly group, C0 was >100 μg/L in the markedly group, and the difference was statistically significant (P<0.05)；while the difference of C2 between the 2 groups was no statistical significance (P>0.05). 3 months later, compared with the not markedly group, the changes of C0 and C2 were no statistical significance (P>0.05), which suggested that there was no obvious correlation between therapeutic effect and CsA blood drug concentration. ConclusionsThe addition of CsA could improve the prognosis of refractory ITP, maintained the normal range of C0 as well as increased the level of PLT and keeped it stabile.

收稿日期：2015-10-20

Analysis of the efficacy of the concentration of cyclosporine A on immune thrombocytopenic purpura(SHENShu.Pharmacydepartment,LiyangCitypeople’shospital,Jiangsu213300,China.)

【Key words】cyclosporine A, immune thrombocytopenic purpura, blood platelet count

免疫性血小板减少性紫癜(Immune thrombocytopenic purpura，ITP)是临床中最常见的一种不明原因的出血性疾病，主要特征为血小板减少、骨髓巨核细胞正常或增多等[1]。糖皮质激素是ITP治疗最基本、有效的药物，但仍有11%～35%的患者治疗效果不佳，反复发作，表现为难治性ITP[2]。环孢素A(CsA)是近年来应用于各种免疫性疾病的新型免疫制剂，是治疗难治性ITP的重要药物[3,4]，由于该药口服制剂生物利用度低，血药浓度不稳定，可能会影响ITP患者的疗效，本研究测定12例难治性ITP患者CsA血药浓度，分析其对ITP临床疗效的影响，现报道如下。

1.材料……