Analysis of application of Recombinant Human Thrombopoietin in patients with liver disease complicated with thrombocytopenia

Abstract

Abstract: Objective To analyze the application effect of Recombinant Human Thrombopoietin (Tpiao) in patients with liver disease complicated with thrombocytopenia.Methods A total of 120 patients with liver disease and thrombocytopenia admitted to our hospital from March 2020 to March 2021 were selected and divided into control group and study group, which were treated with dexamethasone and the study group was treated with Tpiao. The liver function index, coagulation function, blood routine, inflammation related index, immune related index and platelet count (PLT) levels were compared, and the effectiveness and safety were analyzed.Results The levels of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TBIL) in the study group were respectively [(28.89 ± 6.55) U/L], [(33.14 ± 5.56) U/L], [(16.98±3.63)μmol/L] lower than those in the control group (P<0.05). The levels of WBC, red blood cell (RBC), prothrombin time (PT) and activated partial thromboplastin time (APTT) in the study group were higher than those in the control group, and the levels of hemoglobin (HGB), albumin (ALB), thromboplastin (TP) and plasma thromboplastin antecedent (PTA) were higher than those in the control group (P<0.05). The levels of IL-1, IL-6, IL-10, C-reactive protein (CRP), and CD8+ in the study group were lower than those in the control group, and the levels of CD4+, CD4+/CD8+ were higher than those in the control group (P<0.05). The level of PLT in the study group was [(114.32±11.86)×10⁹/L] higher than that in the control group (P<0.05). The total effective rate of the study group was 93.33%, which was lower than that of the control group, which was 80.00% (χ² = 4.615, P=0.032). The adverse reactions in the study group were lower than those in the control group (P<0.05). The mortality rate of the study group was 1.67%, lower than that of the control group (11.67%) (χ²=4.821, P=0.028).Conclusion Tpiao can significantly improve the functional abnormalities of liver disease patients with thrombocytopenia, increase PLT content, reduce mortality, with high effectiveness and high safety, the incidence of adverse events is low, can be used for the treatment of this disease.

Key words: Tpiao, Liver disease, Thrombocytopenia, Platelet count

CUI Da-guang, XIAO Ling-yan, SHI Dong-yang, LIU Yong-fu, ZHANG Shu-ai, YANG Kai, ZHENG Yi-shan. Analysis of application of Recombinant Human Thrombopoietin in patients with liver disease complicated with thrombocytopenia[J]. Chinese Hepatolgy, 2022, 27(12): 1335-1339.

References

[1] Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int, 2017,37:778-793.
[2] Saab S, Brown RS Jr. Management of thrombocytopenia in patients with chronic liver disease. Dig Dis Sci, 2019,64:2757-2768.
[3] Yu Y, Wang M, Hou Y, et al. High-dose dexamethasone plus recombinant human thrombopoietin vs high-dose dexamethasone alone as frontline treatment for newly diagnosed adult primary immune thrombocytopenia: a prospective, multicenter, randomized trial. Am J Hematol, 2020,95:1542-1552.
[4] Cheloff AZ, Al-Samkari H. Avatrombopag for the treatment of immune thrombocytopenia and thrombocytopenia of chronic liver disease. J Blood Med, 2019,10(1):313-321.
[5] Xu H, Cai R. Avatrombopag for the treatment of thrombocytopenia in patients with chronic liver disease. Expert Rev Clin Pharmacol, 2019,12:859-865.
[6] Saab S, Bernstein D, Hassanein T, et al. Treatment options for thrombocytopenia in patients with chronic liver disease undergoing a scheduled procedure. J Clin Gastroenterol, 2020,54:503-511.
[7] Liu Y, Jin G, Sun J, et al. Recombinant human thrombopoietin in critically ill patients with sepsis-associated thrombocytopenia: A clinical study. Int J Infect Dis, 2020,98:144-149.
[8] Mahat U, Rotz SJ, Hanna R. Use of thrombopoietin receptor agonists in prolonged thrombocytopenia after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant, 2020,26:e65-e73.
[9] Mei H, Xu M, Yuan G, et al. A multicentre double-blind, double-dummy, randomised study of recombinant human thrombopoietin versus eltrombopag in the treatment of immune thrombocytopenia in Chinese adult patients. Br J Haematol, 2021,195:781-789.
[10] Kong Z, Qin P, Xiao S, et al. A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy. Blood, 2017,130:1097-1103.
[11] Chen Y,Xie Y, Ruan M, et al. The levels of T lymphocyte subsets in immune thrombocytopenia associated with anti-GPIIb/IIIa- and/or anti-GPIbα-mediated responses are differentially sensitive to dexamethasone. Acta Haematol, 2018,140:60-66.
[12] Cao J, Zhang C, Han X, et al. Emerging role of stem cell memory-like T cell in immune thrombocytopenia. Scand J Immunol, 2019,89:e12739.
[13] Li L, Zhao Y, Tong X, et al. The predictive value of regulatory T cells on glucocorticoid sensitivity in patients with immune thrombocytopenia: a multicentre, prospective clinical study. Br J Haematol, 2021,193:619-627.
[14] Stimpson ML, Lait PJP, Schewitz-Bowers LP, et al. IL-10 and IL-17 expression by CD4+ T cells is altered in corticosteroid refractory immune thrombocytopenia (ITP). J Thromb Haemost, 2020,18:2712-2720.
[15] Kawaguchi T,Umekita K, Yamanaka A, et al. Impact of C-reactive protein levels on differentiating of severe fever with thrombocytopenia syndrome from Japanese spotted fever. Open Forum Infect Dis, 2020,7:ofaa473.