皮质类固醇联合促血小板生成素受体激动剂治疗成人原发免疫性血小板减少症疗效和安全性的系统评价

刘真瑜; 杜颖; 袁怡宁; 潘梦格; 徐玮潞; 许佩佩

doi:10.13748/j.cnki.issn1007-7693.20251316

皮质类固醇联合促血小板生成素受体激动剂治疗成人原发免疫性血小板减少症疗效和安全性的系统评价

Systematic Evaluation of the Efficacy and Safety of Corticosteroids Combined with Thrombopoietin Receptor Agonists in the Treatment of Adult Primary Immune Thrombocytopenia

摘要

摘要:
目的系统评价皮质类固醇联合促血小板生成素受体激动剂(thrombopoietin receptor agonist，TPO-RA)类药物治疗成人原发免疫性血小板减少症(immune thrombocytopenia，ITP)的有效性及安全性。
方法检索中国知网、维普、万方、CBM、PubMed、EMbase、the Cochrane Library数据库，检索时限为建库至2024 年 12月 23 日。收集皮质类固醇联合TPO-RA类药物治疗成人原发ITP的随机对照试验(randomized controlled trial，RCT)。筛选文献、提取数据并进行文献质量评价后，应用 RevMan 5.4及StataNow 18 MP软件进行meta分析。
结果纳入9项RCT，共567例患者。Meta分析结果显示，相比于皮质类固醇或TPO-RA 类药物单药治疗，皮质类固醇联合TPO-RA类药物的临床总有效率显著提高RR=1.30，95%CI(1.20，1.41)，P<0.00001、升高血小板水平的效果增强RR=1.59，95%CI(1.32，1.92)，P<0.00001；二者的不良反应发生率比较，差异无统计学意义RR=0.73，95%CI(0.48，1.13)，P=0.16。
结论对比单采用皮质类固醇药物或TPO-RA类药物治疗而言，皮质类固醇联合TPO-RA类药物可以提高治疗成人原发ITP的有效率，改善血小板水平，且未增加不良反应发生风险。

Abstract:
OBJECTIVE To systematically evaluate the efficacy and safety of corticosteroids combined with thrombopoietin receptor agonist(TPO-RA) in treating adult primary immune thrombocytopenia(ITP).
METHODS Literatures were retrieved from CNKI, VIP, Wanfang, CBM, PubMed, EMbase, and the Cochrane Library database, with the retrieval time limit from the establishment of each database to December 23, 2024. Randomized controlled trials(RCTs) regarding the treatment of adult primary ITP with corticosteroids combined with TPO-RAs were collected. After literature screening, data extraction and quality evaluation of the included studies, meta-analysis was performed using RevMan 5.4 and StataNow 18 MP software.
RESULTS Nine RCTs involving a total of 567 patients were included. Meta-analysis showed that compared with corticosteroid or TPO-RA monotherapy, corticosteroid combined with TPO-RA had significantly higher overall clinical efficacyRR=1.30, 95%CI(1.20, 1.41), P<0.00001 and enhanced effect of elevating platelet levelsRR=1.59, 95%CI(1.32, 1.92), P<0.00001; the incidence of adverse events was not statistically significant when comparing the 2 groupsRR=0.73, 95%CI(0.48, 1.13), P=0.16.
CONCLUSION Versus treatment with corticosteroids alone, or TPO-RA, corticosteroids in combination with TPO-RA may improve the efficiency of treating adult primary ITP and increase platelet levels more effectively, with no elevated risk of adverse effects.

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