小剂量利妥昔单抗联合环孢素A对难治复发性特发性血小板减少性紫癜的疗效评价  

Low dose rituximab combined with cyclosporine A in the treatment of refractory recurrent idiopathic thrombocytopenic purpura

作　　者：董巍巍[1] 代萍[1] 郑桂仙[1] 陈艳梅[1] 董霞 DONG Wei-wei;DAI Ping;ZHENG Gui-xian;CHEN Yan-mei;DONG Xia(Department of Hematology,Zigong Fourth People′s Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第四人民医院血液科,四川自贡643000 [2]自贡市中医医院肿瘤血液科,四川自贡643010

出　　处：《中国临床研究》2021年第2期205-207,212,共4页Chinese Journal of Clinical Research

基　　金：四川省卫生厅科研课题项目(130274)。

摘　　要：目的探讨小剂量利妥昔单抗联合环孢素A对难治复发性特发性血小板减少性紫癜(ITP)患者CD20^(+)、血小板计数的影响及安全性评价。方法选择自贡市第四人民医院2014年1月至2016年1月收治的58例难治复发性ITP患者进行研究,随机分为对照组和观察组,各29例。对照组患者给予地塞米松,观察组患者给予小剂量利妥昔单抗联合环孢素A对进行治疗,疗程周期为3~4个月。动态监测分析两组患者的临床疗效、CD20^(+)指标变化、血小板计数的变化情况,同时记录患者的不良反应。结果治疗后,观察组总有效率高于对照组(89.66%vs 65.52%,χ^(2)=4.858,P<0.05);观察组血小板计数水平显著高于对照组,CD20^(+)水平显著低于对照组(P<0.05);同时两组患者在治疗中出现肝肾功能损伤、发热、肺部感染、皮疹和消化道感染不良反应,但总发生率差异无统计学意义(P>0.05)。结论小剂量利妥昔单抗联合环孢素A对难治复发性ITP患者具有较好的临床效果,能有效改善患者的CD20^(+)和血小板计数表达水平,同时具有较好的安全性。Objective To investigate the effect and safety of low-dose rituximab combined with cyclosporine A on CD20^(+)and platelet count in patients with refractory and recurrent idiopathic thrombocytopenic purpura(ITP).Methods A total of 58 patients with refractory recurrent ITP who received treatment from January 2014 to January 2016 at Zigong Forth People’s Hospital were selected as study subjects,and all the patients were divided into control group and observation group randomly(n=29,each).The control group was treated with dexamethasone,and the observation group was treated with low dose of rituximab and cyclosporine A.The period of treatment was 3-4 months.The clinical efficacy,changes of CD20^(+)and platelet count of the two groups were dynamically monitored and analyzed.Results After treatment,the total effective rate of the observation group was higher than that of the control group(89.66%vs 65.52%,χ^(2)=4.858,P<0.05).Compared with control group,the platelet count in the observation group was significantly higher and the level of CD20^(+)was significantly lower in the observation group(P<0.05).Liver and kidney function injury,fever,pulmonary infection,rash and digestive tract infection adverse reactions occurred in the two groups without significant difference(P>0.05).Conclusion Low dose rituximab combined with cyclosporine A has good clinical effect in the treatment of refractory and recurrent ITP,which could effectively improve the expression level of CD20^(+)and platelet count with good safety.

关 键 词：特发性血小板减少性紫癜 难治 复发 利妥昔单抗 环孢素A 血小板计数 

分 类 号：R544+.6[医药卫生—心血管疾病]