成人慢性原发性ITP患者利妥昔单抗疗效的影响因素及Plt计数预测价值探讨

Influencing Factors on Prognosis of Adult Patients with Chronic Primary ITP Treated with Rituximab and Predictive Value of Platelet Count

目的:探讨成人慢性原发性免疫性血小板减少症(ITP)患者利妥昔单抗疗效的影响因素及血小板(Plt)数预测价值。方法:回顾性分析本院2012年1月-2016年12月收治的52例行利妥昔单抗治疗成人慢性原发性ITP患者的临床资料,其中治疗失败32例设为A组,治疗成功20例设为B组,分析影响利妥昔单抗疗效的独立危险因素,观察首次诊断骨髓CD41^+巨核细胞计数对治疗随访1年患者治疗反应率的影响,计算Plt数用于疗效预测时,效能指标及最佳截断点。结果:B组首次诊断骨髓CD41^+巨核细胞数水平高于A组(P<0.05)。多因素Logistic回归模型分析结果显示,首次诊断骨髓CD41^+巨核细胞数<150是影响利妥昔单抗疗效的独立危险因素(OR=5.40,95%CI:1.82-15.66,P=0.00)。首次诊断骨髓CD41^+巨核细胞数≥150组患者随访1年反应率显著高于<150组(P<0.05)。B组利妥昔单抗首次治疗后d 3、14、21、30、60、90、180、270和360 Plt数水平显著低于A组(P<0.05)。ROC曲线分析结果显示,Plt数最佳截断点为50×10^9/L;利妥昔单抗首次治疗后d14,AUC为0.68(95%CI:0.57-0.78,P=0.00);成人慢性原发性ITP患者利妥昔单抗疗效预测敏感度和特异度分别为48.73%和87.58%;利妥昔单抗治疗后d 30和60 AUC分别为0.74(95%CI:0.64-0.87)(P=0.00)和0.93(95%CI:0.82-0.98)(P=0.00)。结论:成人慢性原发性ITP患者接受利妥昔单抗治疗后,部分可获得长期缓解,但骨髓巨核细胞数<150的患者预后较差;同时根据利妥昔单抗治疗后d 14、30及60 Plt数能够有效预测患者的远期疗效,指导治疗的方案制定。

Objective:To investigate the influencing factors on prognosis of adult patients with chronic primary immune thrombocytopeuia(ITP)after rituximab treatment and predictive value of platelet(Plt)count.Methods:Clinical data of 52 adult patients with chronic primary ITP treated with rituximab from January 2012 to December 2016 were retrospectively analyzed,including 32 patients for failed in treatment as group A and 20 patients for succeeded in treatment as group B.The independent risk factors influencing the clinical efficacy of rituximab were analyzed.The influence of CD41^+megakaryocyte count in bone marrow diagnosed for first time on the response rate of patients with 1-year followed-up were observed,and the Plt count were calculated to predict the clinical efficacy index and the best cutoff point.Results:The CD41^+megakaryocyte count in bone marrow for first time treatment in group B were significantly higher than that in group A(P<0.05).Multivariate Logistic regression analysis showed that the number of CD41^+megakaryocytes in bone marrow<150 at first diagnosis was the independent risk factor influencing the clinical efficacy of rituximab(OR=5.40,95%CI:1.82-15.66,P=0.00).The response rate of 1-year followed-up in patients with CD41^+megakaryocyte count≥150 at first diagnosis was significantly higher than that of CD41^+megakaryocyte count<150(P<0.05).The Plt count level in group B was significantly lower than that in group A at the 3rd,14th,21th,30th,60th,90th,180th,270th and 360th days after first treatment with rituximab(P<0.05).ROC curve analysis showed that the best cut-off point for Plt count was 50×10^9/L and AUC was 0.68 at the 14th day after first treatment with rituximab(95%CI:0.57-0.78,P=0.00).The predictive sensitivity and specificity of clinical efficacy in adult patients with chronic primary ITP treated with rituximab were separately 48.73%and 87.58%,and the AUC in 30th and 60th day after rituximab treatment were separately 0.74(95%CI:0.64-0.87,P=0.00),0.93(95%CI:0.82-0.98,P=0.00).Conclusion:Adult patients with chronic primary ITP may possess long-term remission after rituximab treatment,but the prognosis is poor for patients with bone marrow megakaryocyte count<150.The Plt counts in 14th,30th and 60th days after rituximab treatment can effectively predict the long-term clinical efficacy and guide the formulation of treatment plans.