血浆置换联合利妥昔单抗治疗初诊特发性血栓性血小板减少性紫癜的临床疗效分析

Clinical Efficacy of Plasma Exchange Combined with Rituximab in the Treatment of Initial Diagnosis of Idiopathic Thrombotic Thrombocytopenia Purpura

目的探究血浆置换联合利妥昔单抗治疗初诊特发性血栓性血小板减少性紫癜的临床疗效。方法将2017年1月-2018年12月这一时段内,在该院住院治疗的初诊特发性血栓性血小板减少性紫癜患者5例纳入研究,采集患者临床资料进行回顾性分析,患者入院确诊后,接受血浆置换联合利妥昔单抗治疗,治疗期间监测实验室检查指标变化,记录其治疗效果。结果初诊时,患者血红蛋白水平均低于20×10^9/L,血清乳酸脱氢酶、血清胆红素明显升高,尿隐血阳性,骨髓涂片检查显示活跃增生情况,巨核细胞增生活跃且伴成熟障碍,其中4例贫血,且网织红细胞比例上高,2例肌酐轻度异常上升,1例出现蛋白尿;经治疗,5例患者无出血、精神症状发生,血小板、血清乳酸脱氢酶水平在1个月内恢复症状,随访半年及以上无复发。结论血浆置换联合利妥昔单抗治疗初诊特发性血栓性血小板减少性紫癜,疗效显著,复发率低,值得在临床实践中推广应用。

Objective To explore the clinical effect of plasma exchange combined with rituximab in the treatment of newly diagnosed idiopathic thrombotic thrombocytopenic purpura. Methods Five patients with initial diagnosis of idiopathic thrombotic thrombocytopenic purpura who were hospitalized in our hospital from January 2017 to December 2018 were enrolled in the study. Clinical data were collected for retrospective analysis. Patients were admitted to the hospital for plasma exchange combined with rituximab treatment after diagnosis. Changes in laboratory indicators were monitored, and the therapeutic effects were recorded. Results At the time of initial diagnosis, the patient's hemoglobin level was lower than 20×10^9/L, serum lactate dehydrogenase and serum bilirubin were significantly increased, urine occult blood was positive, bone marrow smear showed active hyperplasia, and megakaryocyte proliferation was active with maturity disorder. There were 4 cases of anemia, with high reticulocyte percentage. There were 2 cases of abnormal creatinine mild rise, and 1 case of proteinuria ensues. After treatment, 5 patients had no bleeding or mental symptoms. And the levels of platelets and serum lactate dehydrogenase recovered within 1 month, with no recurrence after half a year of follow-up. Conclusion Plasma exchange combined with rituximab in the treatment of initial diagnosis of idiopathic thrombotic thrombocytopenic purpura has significantly curative effect and low recurrence rate, which is worth popularizing in clinical practice.