小剂量利妥昔单抗治疗难治性系统性红斑狼疮继发血小板减少的疗效分析

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

目的探讨小剂量利妥昔单抗治疗难治性系统性红斑狼疮继发血小板减少的疗效和安全性。方法选取难治性SLE继发血小板减少患者7例,给予静脉滴注利妥昔单抗200 mg/周,连用2周,监测治疗前后血小板、血清免疫球蛋白定量(IgG、IgM、IgA)、CD_3^+、CD_4^+、CD_8^+、CD_(19)^+B细胞、血B细胞活化因子(BAFF)和疾病活动度评分变化。结果 4周时3例患者达完全有效(CR),4例达部分有效(PR);8周时7例患者均达CR。随访29~182周,3例复发,再次予小剂量利妥昔单抗输注治疗仍有效。4周时7例患者CD_(19)^+细胞计数较治疗前低(P<0.05),其中5例完全清除。7例患者的BAFF水平随着B细胞的清除而升高,恢复而下降。治疗前后血清IgG、IgM、IgA水平及CD_3^+、CD_4^+、CD_8^+B细胞计数差异均无无统计学意义(均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难治性SLE继发血小板减少起效迅速,安全性好。

Objective To evaluate the efficacy and safety of low-dose rituximab for refractory thrombocytopenia in patients with systemic lupus erythematosus （SLE）. Methods Seven patients with thrombocytopenia secondary to refractory SLE were given intravenous infusion of rituximab （200 mg/ week） for two weeks. The levels of serum im-munoglobulin （ IgG, IgM, IgA）, CD3^ ＋ , CD4^ ＋, CD8^＋, CD19^＋ B cells, blood B cell activation factor （ BAFF） and disease activity score were monitored before and after treatment. Results Four weeks after treatment, three patients achieved complete efficacy （CR）, and 4 achieved partial effectiveness （ PR）. Seven patients achieved CR after eight- week treatment. After 29 to 182 weeks follow up, 3 patients relapsed but low-dose rituximab was still effective in these patients. Peripheral CDw^B cells was significantly lower （P 〈 0.05） in all patients after 4 weeks, and five of them were depleted. The BAFF level in seven patients increased with the clearance of B cells and decreased with B cells recovery. The serum IgG, IgM, IgA, CD3^＋, CD4^＋ and CD8＋B cell levels had no significantly change（P 〉 0.05）. No serious adverse side effects occurred during the follow-up period. Conclusions Low-dose rituximab is effective and safety in the treatment of refractory thrombocytopenia secondary to SLE.