小剂量利妥昔单抗联合短期口服泼尼松治疗自身免疫性溶血性贫血的疗效  

Efficacy of low-dose rituximab combined with short-term oral prednisone in the treatment of idiopathic autoimmune hemolytic anemia

作　　者：陆欣[1] 王海军[1] 赵丽云[1] 李玉伟[2] 王助衡[2] 

机构地区：[1]河北医科大学附属邢台市人民医院血液科,河北邢台054031 [2]北京市大兴区人民医院重症医学科

出　　处：《临床血液学杂志》2015年第2期229-232,共4页Journal of Clinical Hematology

摘　　要：目的：评价小剂量利妥昔单抗联合短期口服泼尼松治疗自身免疫性溶血性贫血（AIHA）的临床疗效。方法：32例确诊的AIHA患者接受小剂量利妥昔单抗（静脉滴注100mg，每周1次，连用4周）联合短期口服泼尼松治疗。分别于治疗后第6、12、24和36个月进行随访，并收集患者临床转归、血常规和溶血性指标等资料。结果：治疗后第6、12、24和36个月，患者的血液学指标均较治疗前明显改善，总缓解率分别为90％、100％、100％和89％，无复发生存率分别为87％、79％、68％和68％。其中温抗体自身免疫性溶血性贫血（WAIHA）患者的总缓解率稍高于冷凝集患者，冷凝集患者的复发风险较WAIHA患者高（HR2．1，95％C10．67．9）。治疗后各时间点红细胞抗体（抗球蛋白试验）均有下降。结论：使用小剂量利妥昔单抗联合短期口服泼尼松治疗AIHA有效，可以使患者缓解，并能够减少自身抗体的产生。Objective：To evaluate the sustained response to low-dose rituximab combined with short-term oral prednisone in the treatment of autoimmune hemolytic anemia （AIHA）. Method： A total of 32 patients diagnosed AIHA were treated with low-dose rituximab （100 mg fixed dose and 4 weekly infusions） along with a short course of oral prednisone. The clinical examination, blood counts and hemolytic markers were collected at 6,12,24 and 36 months. Result： A satisfactory response was achieved at all time points compared to enrollment. The overall response was 90 %, 100 %, 100 % and 89 %, and the relapse-free survival rate was 87 %, 79 %, 68 % and 68 % at 6,12, 24,and 36 months,respectively. Response rate was slightly higher in warm-antibody reactive autoimmune haemo lytic anaemia （WAIHA） than that in hemagglutinin disease （CHD） ,and relapse risk was higher in CHD than that in WAIHA （HR 2.1,95 %CI 0.6 to 7.9）. Anti-RBC antibody production by mitogen-stimulated direct antiglobulin test significantly decreased at all time points. Conclusion： Low-dose rituximab combined with short-term oral pred- nisone treatment is effective and induces sustained responses in AIHA,and it can down-regulate the autoantibody production.

关 键 词：贫血 溶血性 自身免疫性 利妥昔单抗 冷凝集素病 温抗体 抗体治疗 

分 类 号：R556.6[医药卫生—血液循环系统疾病]