利妥昔单抗治疗不同激素敏感性ITP患者的疗效观察

Curative effect observation of rituximab in the treatment of ITP patients with different hormone sensitivity

目的 观察比较糖皮质激素敏感和无效的免疫性血小板减少症（ITP）患者应用利妥昔单抗治疗的疗效,以指导ITP患者用药.方法 对52名既往对糖皮质激素无效（n=9）和对糖皮质激素依赖（n=43）的ITP患者予以大剂量地塞米松与小剂量利妥昔单抗联合治疗.结果 经大剂量地塞米松联合利妥昔单抗治疗后1,3,6及12个月,对糖皮质激素无效和存在糖皮质激素依赖的ITP患者总有效率分别为44.4%vs 90.7%;33.3%vs 81.4%;22.2%vs 76.7%;22.2%vs 74.4%.进一步分析了治疗后1,3,6及12个月两组ITP患者调节性T细胞（Treg细胞）比例分别为（1.63±0.68）vs（3.44%±1.11%）;（1.59%±0.62%）vs（4.47%±1.20%）;（1.50%±0.86%）vs（4.32%±1.56%）;（3.45%±1.14%）vs（4.56%±1.67%）.其中在治疗后3、6个月时,两组ITP患者间Tregs细胞水平差异有统计学意义（P＜0.05）对于糖皮质激素敏感的ITP患者细胞因子白细胞介素-2（IL-2）均较治疗前有明显降低,且结果与治疗前相比差异有统计学意义（P＜0.05）,比较来看,糖皮质激素无效患者虽然也有明显降低,但差异无统计学意义（P＞0.05）.结论 既往对糖皮质激素敏感或存在依赖的患者应用利妥昔单抗后疗效更高,Treg细胞对、IL-2调节是其影响因素.

Objective To study and compare the efficacy of rituximab in the treatment for ITP patients who were sensitive and not sensitive to glucoeorticoid, and guide the ITP patients to take medicines. Methods A large dose of dexamethasone combined with a small dose of rituximab were used in the treatment of 52 cases IPT patients who were not sensitive to gluco- cortieoid （n=9） and dependent on glucocorticoid （n=43） previously. Results After the treatment of large dose of dexametha- sone combined with small dose of rituximab, the effectiveness on the insensitive IPT patients, and the glucocortieoid-depen- dent IPT patients at 1, 3, 6 and 12 months were 44.4% vs 90.7%; 33.3% vs 81.4%; 22.2% vs 76.7%; 22.2% vs 74.4%. At 1, 3, 6 and 12 months after treatment, the proportion of adjustment of T cells （Treg cells） of ITP patients were （1.63%±0.68%） vs （3.44%±1.11%）, （1.59%±0.62%）vs （4.47%±1.20%）, （1.50%±0.86%）vs （4.32%±1.56%）, （3.45%±1.14%）vs （4.56%± 1.67%） respectively, and the level of Treg cells had significant between the IPT patients at 3, 6 months after treatment （P〈 0.05）. After treatment, the levels of cytokines IL-2 in glucoeorticoid sensitive IPT patients were dropped significantly than before, and the difference had statistical significance （P〈0.05）. Compared with the conditions before treatment, the glucocorti- eoid insensitive IPT patients reduced, but the difference had no statistical significance （P〉0.05）. Conclusion The use of ritux- imab in IPT patients with previous glucocortieoid insensitivity or glucocorticoid dependence shows high efficacy, it is the fac- tor to the Treg cells and cytokines IL-2.