小剂量美罗华联合重组人血小板生成素治疗难治性ITP疗效以及对细胞免疫功能的影响

Effect of lower-dose rituximab combined with recombinant human thrombopoietin in treatment of patients with refractory primary immune thrombocytopenia and the influence on the cellular immune function

目的探讨小剂量美罗华联合重组人血小板生成素(recombinant human thrombopoietin,rh TPO)治疗难治性免疫性血小板减少症(primary immune thrombocytopenia,ITP)疗效以及对细胞免疫功能的影响。方法选取难治性ITP患者43例,分为观察组(n=23)和对照组(n=20),观察组给予小剂量美罗华联合重组人血小板生成素治疗,对照组给予重组人血小板生成素治疗,2组均治疗1个月,观察并比较2组治疗疗效以及治疗前后血小板计数(PLT),T、B淋巴细胞的变化。结果治疗1个月后,观察组和对照组总有效率分别为78.26%、70%,差异无统计学意义,治疗3个月后,观察组和对照组总有效率分别为73.91%、40%(P<0.05);2组治疗后PLT水平均时间延长而升高,且观察组PLT水平升高幅度大于对照组(P<0.05);2组治疗后,CD4+、CD4+/CD8+均显著上升,CD8+均显著下降(均P<0.05),观察组CD19+/CD20+显著下降(P<0.05),而对照组CD19+/CD20+差异无统计学意义。结论小剂量美罗华联合重组人血小板生成素治疗难治性ITP有效,能显著增强患者细胞免疫功能,联合治疗比单用重组人血小板生成素疗效时间更长。

Objective To investigate the therapeutic effect of lower-dose rituximab combined with recombinant human thrombopoietin （rhTPO） in treatment of patients with refractory primary immune thrombocytopenia （ITP） and the influence on the function of immune cells. Methods 43 cases of refractory ITP patients were divided into the observation group （ n = 23 ） and the control group （ n = 20）, the observation group was given lower-dose rituximab combined with rhTPO treatment, the control group was given only rhTPO treatment. Both two groups were treated for one month, the therapeutic effect of the two groups and the changes of platelet count （ PLT）, T and B lymphoeytes before and after treatment were observed and compared. Results After a month of treatment, the total effective rate of the observation group and the control group were 78.26% and 70% respectively, after three months of treatment, the total effective rate of the observation group and the control group were 73.91% and 40% respectively （P 〈 0. 05） ; After treatment, both two group patients＇ PLT levels were significantly higher than before treatment （ P 〈 0. 05 ） ; PLT after treatment rised, and the PLT in observation group elevated greater than the control group （ P 〈 0. 05 ） ; After treatment, the level of CD4 ＋ , CD4 ＋/CD8 ＋ increased significantly in two groups, and CD8 ＋ were decreased significantly（ P 〈 0. 05 ）. CD19 ＋/CD20 ＋ levels decreased significantly in the observation group （P〈0.05）, while the level of CD19＋/CD20＋ in the control group had no significant difference. Conclusion Lower-dose rituximab combined with rhTPO treatment could effectively treat refractory ITP, it could significantly enhance the cellular immune function of patients, and the curative effect time of combined treatment is longer than the single use of rhTPO.