小剂量利妥昔单抗治疗系统性红斑狼疮继发难治性血小板减少的疗效及安全性分析  

Efficacy and safety of low-dose rituximab in the treatment of refractory thrombocytopenia secondary to systemic lupus erythematosus

作　　者：李金铭 陈琳[2] 姜国平[2] 李慧颖[2] 吕英春[2] 江涛 孟天犁 吕程 LI Jin-Ming;CHEN Lin;JIANG Guo-ping(Changchun University of traditional Chinese Medicine,Changchun 130000,China;The People's Hospital of Jilin Province,Changchun 130021,China)

机构地区：[1]长春中医药大学,吉林长春130000 [2]吉林省人民医院,吉林长春130021

出　　处：《吉林医学》2021年第4期966-969,共4页Jilin Medical Journal

摘　　要：目的:本研究通过应用生物制剂利妥昔单抗治疗系统性红斑狼疮继发难治性血小板减少的患者,从而评价利妥昔单抗在该病中的疗效与安全性。方法:选择系统性红斑狼疮继发难治性血小板减少患者8例,给予静脉滴注利妥昔单抗100mg/周,连用4周;监测治疗前后血小板计数、血清免疫球蛋白定量(IgG、IgM、IgA、IgE)、CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)、B细胞、NK细胞、红细胞沉降率、C-反应蛋白、补体,并记录相应临床表现、疾病活动度评分变化及不良反应相关指标。结果:4周时5例患者达完全有效(CR),应用利妥昔单抗后,血小板计数有整体升高趋势,其中治疗后第3周、第4周比较,差异有统计学意义(P<0.05)。随访24~96周,2例复发,再次予小剂量利妥昔单抗输注治疗仍有效。治疗前后血清IgG、IgM、IgA、IgE水平及CD_(3)^(+)、CD_(4)^(+)/CD_(8)^(+)细胞计数差异均无统计学意义(P>0.05),但SLEDAI评分、血沉、补体C3、C4差异有统计学意义(P<0.05)。随访期间无严重不良反应发生。结论:小剂量利妥昔单抗治疗系统性红斑狼疮继发难治性血小板减少症的疗效较好,起效较快,安全性较好。Objective In this study,the biological agent rituximab was used to treat patients with refractory thrombocytopenia secondary to systemic lupus erythematosus(SLE)to evaluate its efficacy and safety.Method 8 patients with refractory thrombocytopenia secondary to systemic lupus erythematosus were selected and given rituximab 100 mg/week by intravenous infusion for 4 weeks;the platelet count and serum immunoglobulin quantification(IgG,IgM,IgA,IgE),CD_(3)^(+),CD_(4)^(+)/CD_(8)^(+),B cells,NK cells,erythrocyte sedimentation rate,C-reactive protein,complement was monitored and related clinical manifestations,changes of disease activity score and adverse reaction related indicators was recorded.Results 5 patients reached complete response(CR)after 4 weeks.After the application of rituximab,the platelet count showed an overall upward trend,and the difference of treatment between 3 and 4 weeks was statistically significant(P<0.05).During a follow-up of 24 to 96 weeks,2 cases relapsed,and the reuse of low-dose rituximab infusion was still effective.There were no significant differences in serum IgG,IgM,IgA,IgE levels and CD_(3)^(+),CD_(4)^(+)/CD_(8)^(+)cell counts before and after treatment(P>0.05),but the differences in SLEDAI score,erythrocyte sedimentation rate,complement C3,and C4 were statistically significant(P<0.05).No serious adverse reactions occurred during the follow-up period.Conclusion Low-dose rituximab is effective in treating refractory thrombocytopenia secondary to systemic lupus erythematosus,with a relatively quick onset and safe result.

关 键 词：利妥昔单抗 系统性红斑狼疮 难治性血小板减少 疗效性 

分 类 号：R593.241[医药卫生—内科学] R558.2[医药卫生—临床医学]