利妥昔单抗联合常规治疗自身免疫性溶血性贫血的疗效观察

Observation of Clinical Effects of Rituximab Combined with Conventional Therapy on Treatment of Autoimmune Hemolytic Anemia

目的:探讨利妥昔单抗联合常规治疗自身免疫性溶血性贫血(AIHA)的临床疗效及对患者血清学特征的影响。方法:88例AIHA患者随机分为观察组和对照组各44例。将观察组再分为温抗体自身免疫性溶血性贫血(WAIHA)和冷凝集素病(CHD)两个亚组。对照组给予口服叶酸、泼尼松,大剂量静注丙种球蛋白等常规治疗;观察组在对照组基础上加用利妥昔单抗,每周静滴1次。两组均连续治疗4周。观察治疗前后观察组各亚组和对照组患者血常规及乳酸脱氢酶、胆红素水平变化,评估临床疗效及药品不良反应。结果:观察组总有效率和完全缓解率均显著高于对照组(P<0.05),复发率显著低于对照组(P<0.05)。WAIHA亚组总有效率和完全缓解率显著高于CHD亚组(P<0.05)。治疗后两组患者血红蛋白、网织红细胞、乳酸脱氢酶、胆红素等指标均较治疗前显著改善(P<0.05),且观察组各项指标均优于对照组(P<0.05)。治疗前,WAIHA亚组血红蛋白、网织红细胞、乳酸脱氢酶、胆红素均显著低于CHD亚组(P<0.05),治疗后WAIHA亚组上述指标改善程度优于CHD亚组(P<0.05)。两组药品不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在传统治疗基础上联合利妥昔单抗治疗AIHA临床效果好,复发率低,且安全性高,对WAIHA效果更佳。

Objective： To study the clinical efficacy of rituximab combined with conventional therapy on the treatment of autoimmune hemolytic anemia（ AIHA）, and its influence on patients serological features. Methods：88 cases of AIHA patients were randomly divided into the observation group and the control group （44 cases in each group） ; And the observation group was divided into the warm antibody autoimmune hemolytic anemia （WAIHA subgroup） and the cold agglutinin disease （CHD subgroup）. The control group was treated with folic acid, prednisone and large dose intravenous gamma globulin , while the observation group was given intravenous infusion of rituximab once a week for 4 weeks on basis of the control group treatment. The blood lactate dehydrogenase, bilirubin level changes, clinical efficacy and adverse drug reactions of the two groups and subgroups of observation group were evaluated and compared before and after treatment. Results：The total effective rate and the complete remission rate of observation group were significantly higher than those in control group （ P 〈 0.05 ）, while the recurrence rate was significantly lower than that of control group （ P 〈 0.05）. The total effective rate and the complete remission rate of WAIHA subgroup were significantly higher than those of CHD subgroup（P 〈 0.05）. After treatment, the hemoglobin, reticulocytes, LDH and bilirubin of two groups were all significantly improved than before（P 〈 0.05）, and those indexes of observation group were much better than that of control group （P 〈 0.05 ）. Before treatment, the hemoglobin, reticulocytesl LDH and bilirubin degree of WAIHA subgroup were significantly lower than those of CHD subgroup （P 〈 0.05）. After treatment, those indexes of WAIHA subgroup had more obvious improvement than those of CHD subgroup （ P 〈 0.05）. The incidence of adverse drug reactions of the two groups had no significantly differences （ P 〉 0.05）. Conclusion： Rituximab combined with conventional therapy to treat AIHA had better clinical effect and lower recurrence rate, which has better effects for WAIHA.