The Effect Of Glucocorticoid Combined With RhTPO And Glucocorticoid Combined With Gamma Globulin In Treatment Of Severe ITP And Its Effect On IL-17

Objectives:The purpose of this prospective study was to compare the efficacy and safety of glucocorticoid combined with recombinant human thrombopoietin(rhTPO)and glucocorticoid combined with intravenous gamma globulin(IVIG)in the treatment of adult newly diagnosed severe primary immune thrombocytopenia(ITP).And to explore the effect of different treatment schemes on the expression of cytokine interleukin-17(IL-17)in peripheral blood.Methods:A total of 66 adult patients with severe ITP treated in the Department of Hematology,affiliated Hospital of North Sichuan Medical College from June 2017 to June 2019 were randomly divided into glucocorticoid plus rhTPO group(n=32)and glucocorticoid combined with IVIG group(n=34).Glucocorticoid was converted into the same dose of methylprednisolone intravenously or orally according to prednisone lmg/kg.d,and the dose of methylprednisolone began to decrease after 4 weeks in all patients,and rhTPO 15000IU/d × 14 days,if the platelet level was? 100 ×109/L for less than 14 days,then stop using rhTPO;IVIG:400mg/kg.d ×3-5 days.The changes of platelet count,total effective rate,effective time,bleeding control time,efficacy maintenance time,incidence of adverse reactions and economic cost were compared between the two groups after treatment.The expression level of IL-17 in peripheral blood of the two groups before and after treatment was detected by enzyme-linked immunosorbent assay(Enzyme-Linked ImmunoSorbent Assay,ELISA),and the differential expression of IL-17 in peripheral blood was analyzed.The statistical data were analyzed by SPSS 25.0.the counting data were expressed in rate(%).Using ?2 test,the measurement data in accordance with normal distribution were expressed as mean plus or minus standard deviation(x±s),independent sample t test was used,and the measurement data that did not accord with normal distribution were expressed as median and independent sample nonparametric test was used.The measurement data were all tested by a=0.05,and the difference was statistically significant(P<0.05).Results:Platelet count:on the 3rd,6th and 9th day of treatment,the median platelet count in the glucocorticoid plus IVIG group was significantly higher than that in the glucocorticoid plus rhTPO group(44×109/L vs 12×109/L,P=0.018;129×109/L vs 47.5×109/L,P=0.001;165×109/L vs 97×109/L,P=0.008).But on the 15th day of treatment,the median platelet count in the glucocorticoid plus rhTPO group was significantly higher than that in the glucocorticoid plus IVIG group(181×109/L vs 119×1/L,P=0.02),and the above differences were statistically significant.1.Total effective rate:on the 30th day of treatment,the total effective rate of the glucocorticoid combined with rhTPO group was higher than that of the glucocorticoid plus IVIG group(87.50%vs 64.71%,?1=4.664,P=0.031).2.The median time of onset and bleeding control in the glucocorticoid plus rhTPO group(6 days)was significantly longer than that in the glucocorticoid plus IVIG group(3 days),and the difference was statistically significant(P=0.001),but there was no significant difference in the median bleeding control time between the two groups(2.5 days vs 2 days,P=0.078).3.Duration of efficacy,incidence of adverse reactions,economic cost:duration of efficacy of the two groups(?2months,68.75%vs 58.82%,P=0.402;?3months,59.38%vs 55.88%,P=0.774;?6months,56.25%vs 55.88%,P=0.976),incidence of adverse reactions(53.13%vs 58.82%,P=0.971)and economic cost((10616.72±3351.32)? vs(11342.26±3019.89)?,P=0.358),there was no significant difference.4.IL-17 expression level in peripheral blood:before treatment,there was no significant difference in the expression level of IL-17 in peripheral blood between glucocorticoid plus rhTPO group and glucocorticoid plus IVIG group(18.25±3.84pg/ml vs 17.85±3.70pg/ml,P=0.673).On the 15th and 30th day of treatment,the expression level of IL-17 in glucocorticoid plus rhTPO group was significantly lower than that in glucocorticoid plus IVIG group(12.21±3.30pg/ml vs 17.14±3.10pg/ml,P=0.000;14.59±2.22pg/ml vs 17.26±3.14pg/ml,P=0.000),but on the 60th,90th and 180th day of treatment,there was no significant difference in IL-17 expression level between the two groups(16.74±3.27pg/ml vs 17.30±2.87pg/ml,P=0.559;16.89±3.34pg/ml vs 17.47±2.96pg/ml,P=0.578;17.17±3.30pg/ml vs 17.68±2.66pg/ml,P=0.607).Conclusions:1.Compared with the glucocorticoid plus rhTPO group and the glucocorticoid plus IVIG group,the onset time of glucocorticoid combined with IVIG group was relatively slow,but it did not increase the risk of bleeding,and on the 30th day of treatment,it could improve the total effective rate of severe ITP patients.2.The expression of IL-17 in peripheral blood of ITP patients in glucocorticoid plus rhTPO group was significantly lower than that in glucocorticoid plus IVIG group after treatment.It is speculated that the down-regulation and increase of IL-17 may be one of the effective mechanisms of rhTPO in the treatment of ITP.