利妥昔单抗对B细胞非霍奇金淋巴瘤患者体液免疫的影响

Effect of Rituximab on humoral immunity in patients with B-cell non-Hodgkin's lymphoma

目的探讨利妥昔单抗(RTX)治疗B细胞非霍奇金淋巴瘤(B-NHL)后对患者体液免疫的影响。方法回顾性分析安徽医科大学第二附属医院诊治的86例B-NHL患者,按治疗方案不同分为观察组和对照组,其中使用RTX联合环磷酰胺、多柔比星、长春新碱、泼尼松(R-CHOP)方案治疗为观察组,CHOP方案治疗为对照组,比较两组患者治疗前后外周血中CD20^+正常B淋巴细胞比例、血清中免疫球蛋白及其主要亚型的变化以及治疗过程中感染发生情况。结果①4个疗程后,观察组仅14%(9/64)的患者外周血中检测出CD20^+正常B淋巴细胞,而对照组100%(16/16)患者外周血中CD20^+正常B淋巴细胞均可测出。②观察组患者化疗后外周血免疫球蛋白及其主要亚型IgG、IgA及IgM水平降低(P <0.05),而对照组治疗前后比较差异无统计学意义(P>0.05)。其次,观察组4个疗程后低免疫球蛋白血症发生率高于对照组(P<0.05)。③治疗过程中,观察组患者感染发生率为45.71%,感染事件分级以1、2级为主,占81.25%。4个疗程后,与免疫球蛋白正常的患者比较,出现低免疫球蛋白的患者更易发感染(P<0.05)。结论 RTX治疗B-NHL后会损伤患者体液免疫,同时增加感染事件发生率。因此,化疗期间应动态检测患者血清中免疫球蛋白及其主要亚型的水平,避免感染的发生。

Objective To investigate the effect of Rituximab (RTX) on humoral immunity of patients with B cell Non-Hodgkin lymphoma (B-NHL). Methods Eighty-six B-NHL patients who were diagnosed with B-NHL in The Second Affiliated Hospital of Anhui Medical University were analyzed retrospectively. Patients were divided into observation group and control group. Patients in the observation group received RTX combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimen, and patients in the control group received CHOP treatment. CD20^+ B lymphocytes, serum immunoglobulin as well as major subtypes were compared before and after treatment, and the incidence of infection was recorded. Results After 4 courses of treatment, CD20^+ B lymphocytes occurred in peripheral blood of 14%(9/64) patients in the observation group, while the number was 100%(16/16) in control group. The levels of serum immunoglobulin, IgG, IgA and IgM in the observation group decreased significantly after chemotherapy, while no significant difference in Ig, IgG, IgA or IgM were witnessed before and after treatment in the control group. Incidence of hypo-immunoglobulinemia was significantly increased in the observation group after 4 courses of treatment compared with control group. Infection rate in the observation group was 45.71% and 81.25% of which were grade1-to 2 events. Incidence of infection in patients with low immunoglobulin increased significantly compared with those with normal immunoglobulin. Conclusions RTX treating B-NHL destroys the humoral immunity and increases the incidence of infection. Dynamical measurement of serum immunoglobulin and its major subtypes is necessary for prevention of infectious complications when receiving RTX.