糖皮质激素联合小剂量利妥昔单抗治疗初治和复发原发免疫性血小板减少症的疗效观察

Observation of curative effect of glucocorticoid combined with low-dose rituximab in primary and recurrent primary immune thrombocytopenia

目的比较糖皮质激素联合小剂量利妥昔单抗治疗初治和复发原发免疫性血小板减少症(ITP)的疗效。方法51例患者纳入研究,男17例,女34例,中位年龄27(18~69)岁;初治ITP 28例(初治组),常规糖皮质激素治疗后复发ITP 23例(复发组),其中糖皮质激素依赖20例,糖皮质激素无效3例。治疗方案均为:第1~4天大剂量地塞米松40 mg/d口服,第5~7天泼尼松60 mg/d口服,第8~14天泼尼松30 mg/d口服,第15~21天泼尼松20 mg/d口服,第22~28天泼尼松10 mg/d口服;第7、14、21、28天小剂量利妥昔单抗100 mg静脉输注。观察比较初治组和复发组ITP患者的疗效及安全性。结果治疗第4天,2组血小板计数均较治疗前升高,差异有统计学意义(P<0.05),组间差异无统计学意义(P>0.05);治疗第7天,2组血小板计数继续升高,组间差异无统计学意义(P>0.05);治疗第14、28天,2组血小板计数均处于相对安全水平,组间差异无统计学意义(P>0.05)。治疗第28天和第6个月,初治组患者总有效率均高于复发组,但差异无统计学意义(P>0.05)。2组不良反应发生率的差异无统计学意义(P>0.05)。结论糖皮质激素联合小剂量利妥昔单抗治疗初治和复发原发免疫性血小板减少症的疗效相当,无严重不良反应发生。

Objective To compare the efficacy of glucocorticoid combined with low-dose rituximab in the treatment of primary and recurrent primary immune thrombocytopenia(ITP).Methods A total of 51 patients were included in the study,17 males and 34 females,with a median age of 27(18-69)years;28 patients with initial ITP(initial treatment group),23 patients with recurrent ITP(recurrence group)after routine glucocorticoid treatment,including 20 patients with glucocorticoid dependence and 3 patients with ineffective glucocorticoid.The treatment regimen was:large dose of dexamethasone 40 mg/d on days 1-4,prednisone 60 mg/d on days 5-7,prednisone 30 mg/d on days 8-14,prednisone 20 mg/d on day 15-21,prednisone 10 mg/d on days 22-28,low dose of rituximab 100 mg intravenous drip on days 7,14,21 and 28.The efficacy and safety of ITP patients in initial treatment group and recurrence group were observed and compared.Results On the fourth day of treatment,the platelet count of the two groups was higher than that before treatment,the difference was statistically significant(P<0.05),there was no statistically significant difference between the two groups(P>0.05).On the seventh day of treatment,the platelet count of the two groups continued to rise,without statistically significant difference between the two groups(P>0.05).On the fourteenth and 28th days of treatment,the platelet count of the two groups were in a relatively safe level,without statistically significant difference between the two groups(P>0.05).On the 28th day and the 6th month of treatment,the total effective rate in the initial treatment group was higher than that in the recurrence group,but the difference was not statistically significant(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Glucocorticoid combined with low-dose rituximab has similar efficacy in the treatment of primary and recurrent immune thrombocytopenia,and there is no serious adverse reactions.