慢性肝病血小板低落患者的药物选择 - 肝胆相照论坛

慢性肝病血小板低落患者的药物选择
.

肝病患者中，血小板低落在临床创伤性检查，治疗操作，化疗，和抗病毒治疗过程中造成障碍。刺激骨髓是最具期望和有为的治疗肝病患者血小板低落干预治疗。

血小板生成素的特征和其（非）运作在患者与慢性肝脏病中透露了新治疗机会。的确, 选择为血小板低落症药物治疗可被划分为：靶标治疗，瞄准在血小板生成素的感受器(合成血小板生成素和血小板生成素模仿物), 并且对细胞激素和一般血小板生成素潜力的使用。不幸地, 对合成物质的使用，血小板生成素被中立化的抗体的出现阻碍了, 而且，血小板模仿模式的代理未进入临床研究。白介素-11证明在慢性肝脏病患者增长的血小板计数有用，虽然它的用途由副作用限制。

促红细胞生成素显示在改进血小板低落的硬化患者有效果。对于慢性肝脏病病人, 瞄准改进血小板低落文目的安全的和被容忍的治疗仍然缺乏。需要更大的研究来评估和更好特征化血小板生长素血凝潜力。在人上进行的血小板模仿物的研究和试药迫切地等候对其安全性和有效性的评估。

在目前仍然是应该以白介素-11和促红细胞生成素等作为通过FDA核准的基础治疗。相信，更多血小板生长素和血小板模仿物很多会将上市。这些药物都应该ikeyi促进血小板生成：干细胞系数 stem-cell factor (c-kit ligand), 白介素-1，interleukin (IL)-1, 白介素-3 IL-3, 白介素=6 IL-6, 和白介素-11 IL-11, 和血小板生长素(TPO) 和类似物质。 TPO, c-Mpl ligand - c-mpl的接受器和重组TPO (rhTPO) 是未来的走向。

原文：

Alimentary Pharmacology & Therapeutics
Volume 23 Page 1055 - April 2006
doi:10.1111/j.1365-2036.2006.02889.x
Volume 23 Issue 8

Review article: thrombocytopenia in chronic liver disease and pharmacologic
treatment options
E. G. GIANNINI
Summary

In patients with liver disease, thrombocytopenia is a clinical feature that
may represent an obstacle to invasive diagnostic or therapeutic procedures,
chemotherapy, and anti-viral treatment. Stimulation of the bone marrow is
the most promising therapeutic intervention for thrombocytopenia in patients
with chronic liver disease.

The description of thrombopoietin and its (de)regulation in patients with
chronic liver disease have disclosed new treatment opportunities. Indeed,
pharmacologic treatment options for thrombocytopenia can be divided into
treatments targeted at the thrombopoietin receptor (synthetic
thrombopoietins and thrombopoietin-mimetic agents), and use of cytokines
with general thrombopoietic potential. Unfortunately, use of synthetic
thrombopoietin was hampered by the development of neutralizing antibodies,
and thrombopoietin mimetic agents have not yet entered clinical studies.
Interleukin-11 proved to be useful in increasing platelet count in patients
with chronic liver disease, although its use is limited by side-effects.

Erythropoietin has shown promising results in improving thrombocytopenia in
cirrhotic patients. In patients with chronic liver disease, safe and
well-tolerated treatments aimed at improving thrombocytopenia are still
lacking. Larger studies are needed to evaluate and better characterize the
thrombopoietic potential of erythropoietin. Human studies with
thrombopoietin-mimetic agents are eagerly awaited in order to assess both
effectiveness and safety of these drugs.