Relationship between neutrophil levels and recurrence after high-dose dexamethasone treatment in patients with primary immune thrombocytopenia
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摘要: 目的 分析中性粒细胞水平与原发免疫性血小板减少症(primary immune thrombocytopenia, ITP)患者大剂量地塞米松治疗后复发的关系。方法 纳入2018年10月—2022年4月在医院血液内科接受大剂量地塞米松治疗的100例ITP患者，统计患者治疗有效后复发情况，并分成复发组与未复发组，测定两组基线时及末次治疗时的中性粒细胞水平，并分析中性粒细胞水平与ITP患者大剂量地塞米松治疗后复发关系。结果 100例ITP患者经大剂量地塞米松治疗达治疗有效后，出现16例复发，复发率16.00%；两组末次治疗时中性粒细胞百分比高于基线时水平，差异有统计学意义(P < 0.05)。复发组基线时及末次治疗时中性粒细胞百分比均低于未复发组，差异有统计学意义(P < 0.05)；经点二列相关性证实，基线及末次治疗时中性粒细胞百分比与ITP患者大剂量地塞米松治疗后复发呈负相关(r < 0，P < 0.05)；经限制性立方样条(RCS)分析，ITP患者基线中性粒细胞水平与大剂量地塞米松治疗后复发的关联呈非线性曲线型剂量反应关系，当基线中性粒细胞百分比 < 55.50%时，患者大剂量地塞米松治疗后复发风险随指标水平降低而逐渐增加。结论 中性粒细胞水平与ITP患者大剂量地塞米松治疗后复发有关，患者基线中性粒细胞水平高可能提示ITP患者大剂量地塞米松治疗后复发风险较高，应提高警惕。
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关键词:
- 原发免疫性血小板减少症 /
- 中性粒细胞 /
- 大剂量地塞米松 /
- 复发
Abstract: Objective To analyze the relationship between neutrophil levels and recurrence after high-dose dexamethasone treatment in patients with primary immune thrombocytopenia(ITP).Methods A total of 100 ITP patients who received high-dose dexamethasone treatment in the department of hematology of our hospital from October 2018 to April 2022 were included in the study. The recurrence of ITP patients after effective treatment was counted, and the patients were divided into recurrence group and non-recurrence group. The neutrophil levels at baseline and the last treatment of the two groups were measured, and the relationship between neutrophil levels and recurrence of ITP patients after high-dose dexamethasone treatment was analyzed.Results According to statistics, among 100 ITP patients who achieved effective treatment with high-dose dexamethasone, 16 cases experienced recurrence, with a recurrence rate of 16.00%. The percentage of neutrophils in the two groups during the last treatment was higher than the baseline level, and the difference was statistically significant(P < 0.05). The percentage of neutrophils in the recurrence group at baseline and the last treatment was lower than that in the non recurrence group, and the difference was statistically significant(P < 0.05). Confirmed by point two column correlations, the percentage of neutrophils at baseline and final treatment was negatively correlated with recurrence in ITP patients after high-dose dexamethasone treatment(r < 0, P < 0.05). According to restricted cubic spline(RCS) analysis, there was a non-linear dose-response relationship between baseline neutrophil levels and recurrence after high-dose dexamethasone treatment in ITP patients. When the baseline neutrophil percentage was less than 55.50%, the risk of recurrence after high-dose dexamethasone treatment gradually increased as the indicator level decreased.Conclusion Neutrophil levels were associated with recurrence in ITP patients after high-dose dexamethasone treatment. High baseline neutrophil levels in patients may indicate a higher risk of recurrence in ITP patients after high-dose dexamethasone treatment, and special attention should be paid.-
Key words:
- primary immune thrombocytopenia /
- neutrophils /
- high-dose dexamethasone /
- recurrence
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表 1 两组一般资料及临床指标比较
项目 复发组(n=16) 未复发组(n=84) 统计值 P 性别/例(%) 0.004 0.947 男 7(43.75) 36(42.86) 女 9(56.25) 48(57.14) 年龄/岁 65.75±5.24 64.83±5.74 0.593 0.554 BMI/(kg/m2) 25.15±2.26 24.67±2.20 0.794 0.429 收缩压/mmHga) 113.25±8.81 115.05±8.62 0.762 0.448 舒张压/mmHg 80.13±5.56 79.80±5.53 0.217 0.829 伴出血症状/例(%) 13(81.25) 71(84.52) ＜0.001b) 1.000b) 血小板计数/(×109/L) 21.55±2.95 21.98±3.38 0.480 0.632 血红蛋白/(g/L) 124.25±11.26 121.96±10.91 0.764 0.447 空腹血糖/(mmol/L) 4.10±0.65 4.34±0.86 1.055 0.294 TC/(mmol/L) 2.32±1.09 2.40±0.90 0.317 0.752 TG/(mmol/L) 2.30±0.95 2.18±0.74 0.565 0.574 HDL-C/(mmol/L) 1.30±0.30 1.26±0.32 0.456 0.650 LDL-C/(mmol/L) 1.78±0.42 1.88±0.52 0.732 0.466 注：a)1 mmHg=0.133 kPa；b)采用连续性校正χ2检验。 
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表 2 两组基线及末次治疗时中性粒细胞水平比较
%，X±S 组别 基线中性粒细胞百分比 末次治疗时中性粒细胞百分比 复发组(n=16) 50.69±5.21 57.06±5.731) 未复发组(n=84) 55.71±5.63 61.77±6.031) t 3.307 2.885 P 0.001 0.005 与同组基线中性粒细胞百分比比较，1)P < 0.05。
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表 3 基线及末次治疗时中性粒细胞与ITP患者大剂量地塞米松治疗后复发的相关性
指标 r P 基线中性粒细胞百分比 -0.317 < 0.001 末次治疗时中性粒细胞百分比 -0.280 < 0.001
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