31例小剂量利妥昔单抗联合地塞米松治疗儿童难治性ITP的临床分析  

Low-dose rituximab combined with dexamethasone in the treatment of refractory ITP in children:Clinical analysis of 31 cases

作　　者：孙高源 田新[1] 方春连 甘佳鑫 吴玉虹 毛晓燕 尹润秀 郭怡龄 秦晶晶 SUN Gaoyuan;TIAN Xin;FANG Chunlian;GAN Jiaxin;WU Yuhong;MAO Xiaoyan;YIN Runxiu;GUO Yiling;QIN Jingjing(Kunming Childrens Hospital,Kunming 650100,China;School of Clinical Medicine,Dali University;Kunming Medical University)

机构地区：[1]昆明市儿童医院,云南昆明650100 [2]大理大学临床医学院 [3]昆明医科大学

出　　处：《中国输血杂志》2021年第6期616-619,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨小剂量利妥昔单抗联合地塞米松治疗儿童难治性ITP(RITP)的临床有效性及安全性。方法选取昆明市儿童医院血液科2016年1月2019年12月收治的31例同意接受小剂量利妥昔单抗(100 mg/次,每周1次,连用4周)联合地塞米松(0.6 mg/kg·次,每日1次,连用4 d)药物治疗的RITP患儿进行研究。治疗期间隔日监测血常规,同时记录出现的药物不良反应,并采用χ^(2)检验比较不同性别、病程及年龄段对预后的影响。结果 1)31例患儿中11例(35.5%)4周后血小板>100×10^(9)/L且半年无反复,9例(29%)血小板>30×10^(9)/L但<100×10^(9)/L且半年无反复;11例(35.5%)血小板无回升,持续低于30×10^(9)/L。2)利妥昔单抗使用中,4例(12.9%)出现皮疹,其中1例(3.2%)出现严重的药物性皮疹;2例(6.4%)出现头痛、呕吐、血压升高;1例(3.2%)出现喉头水肿。3)不同性别、年龄、病程的总有效率比较无差异(P>0.05)。结论小剂量利妥昔单抗联合地塞米松二联疗法对儿童难治性ITP半年总有效率达64.5%,不良反应可耐受,可作为难治性ITP患者的一种治疗选择。Objective To investigate the clinical efficacy and safety of low-dose rituximab combined with dexamethasone in the treatment of refractory ITP(RITP) in children. Methods A total of 31 RITP children, admitted to the Hematology Department of Kunming Children′s Hospital from January 2016 to December 2019 and agreed to receive low-dose rituximab(100 mg/time, once a week, for 4 successive weeks) combined with dexamethasone(0.6 mg/kg, once a day, for 4 successive days) were enrolled and studied. Blood routine was monitored every other day during treatment, and adverse drug reactions were recorded. The influence of gender, disease course and age on prognosis was compared by χ^(2) test. Results 1) Among the 31 cases, 11(35.5%) had platelets >100×10^(9)/L after 4 weeks and had no recurrence in 6 months;9(29%) had platelets >30×10^(9)/L but <100×10^(9)/L and had no recurrence in 6 months;11(35.5%) showed no recovery of platelets, which were consistently lower than 30×10^(9)/L. 2) Rituximab was used in 4 cases(12.9%), 1 case(3.2%) presented with severe drug-induced rashes;Headache, vomiting and elevated blood pressure occurred in 2 cases(6.4%). 1 case(3.2%) presented with laryngeal edema. 3) There was no difference in the total effective rate among different gender, age and disease course(P >0.05).Conclusion The total effective rate of low-dose rituximab combined with dexamethasone for children with refractory ITP in 6 months is 64.5%, and the adverse reactions are tolerable, so it can be used as a treatment option for children with refractory ITP.

关 键 词：儿童 免疫性血小板减少症 利妥昔单抗 地塞米松 

分 类 号：R457.1[医药卫生—治疗学]