利妥昔单抗治疗难治性原发性免疫性血小板减少症44例临床观察  

Clinical Observation of Rituximab in the Treatment of 44 Cases of Refractory Primary Immune Thrombocytopenia

作　　者：刘焕凤[1] 张诚[1] 陈幸华[1] 孔佩艳[1] 高力[1] 刘耀[1] 陈婷[1] 罗晓庆[1] 张曦[1] 

机构地区：[1]第三军医大学新桥医院血液科,重庆400037

出　　处：《中国药房》2013年第38期3563-3565,共3页China Pharmacy

基　　金：国家自然科学基金(No.81070388);国家重点基础研究发展计划(973计划)资助课题子课题(No.2012CB518103)

摘　　要：目的:探讨利妥昔单抗治疗难治性原发性免疫性血小板减少症(RITP)的临床疗效。方法:44例RITP患者接受利妥昔单抗治疗,每次采用100 mg/m2,每周1次,至少使用4次。于治疗前及治疗后半年定期检测外周血小板计数、T细胞亚群、血清免疫球蛋白水平,并观察不良反应。结果:16例(36.4%)患者在连续使用利妥昔单抗治疗结束1个月内,血小板计数大于50×109L-1或在原有水平上升30×109L-1;21例(47.7%)患者在使用利妥昔单抗治疗3个月内,血小板计数大于50×109L-1或在原有水平上升30×109L-1;7例(15.9%)患者在连续使用利妥昔单抗治疗6个月后,血小板达不到50×109L-1或在原有水平上升30×109L-1,但出血倾向明显改善。显效30例,良好7例,进步7例,总有效率为84.1%。治疗有效持续35例,其中2例治疗结束后第2个月肺部感染后血小板计数下降至低于50×109L-1,持续有效率为79.5%。所有患者未见严重不良反应。结论:利妥昔单抗治疗RITP疗效确切、安全可靠。OBJECTIVE： To investigate clinical efficacy of rituximab in the treatment of refractory primary immune thrombocy- topenia （RITP）. METHODS： 44 cases of RITP were treated with rituximab. Rituximab was administered at 100 mg/m2 once a week for 4 times at least. Platelet counts, T cell subset and serum immunoglobulin were detected before and half year after thera- py, and adverse drug reactions were observed. RESULTS： After consecutive treatment of rituximab, the platelet count of 16 pa- tients was higher than 50×109 L-1 or increased by 30×109 L-1 within 1 month （36.4%）; the platelet count of 21 patients was more than 50×109 L-1 or increased by 30×109 L-1 within 3 months after rituximab therapy （47.7%） ; the platelet count of 7 patients was lower than 50 ×109 L-1 or increased by 30 ×109 L-1 after 6 months of rituximab therapy （15.9 % ） but hemorrhagic tendency was im- proved significantly. Complete remission was achieved in 30 patients, partial remission was obtained in 7 patients, and 7 patients were considered a treatment progress. The total effective rate was 84.1%. Therapeutic efficacy of 35 patients was persistent, but the platelet count of 2 patients suffering from pulmonary infection decreased to lower than 50x 109 L-t at second month after therapy,with persistent effective rate of 79.5 %. No serious adverse drug reaction was found. CONCLUSIONS： Rituximab is effective, safe and reliable in the treatment of refractory RITP.

关 键 词：原发性免疫性血小板减少症 难治性 利妥昔单抗 

分 类 号：R973[医药卫生—药品] R969.3[医药卫生—药学]