利妥昔单抗联合血浆置换、输注去白红细胞治疗自身免疫性溶血性贫血的效果

Effect of rituximab combined with plasma exchange and infusion of leukocyte-depleted red blood cells in the treatment of autoimmune hemolytic anemia

目的探讨利妥昔单抗联合血浆置换、输注去白红细胞治疗自身免疫性溶血性贫血(AIHA)的效果。方法选取我院收治的68例AIHA患者,按照单盲法将其分为对照组(34例,血浆置换+输注去白红细胞)和观察组(34例,利妥昔单抗+血浆置换+输注去白红细胞)。比较两组的治疗效果、血常规指标、不良反应、输血反应及细胞因子。结果两组的治疗总有效率、不良反应总发生率比较,差异均无统计学意义(P>0.05)。治疗4周后,观察组的TBIL水平明显低于对照组,RBC、Hb水平均明显高于对照组(P<0.05)。观察组的输血反应总发生率明显低于对照组(P<0.05)。治疗1 d、2周、4周后,观察组的IFN-γ、IL-12水平均明显低于对照组,IL-10水平明显高于对照组(P<0.05)。结论利妥昔单抗联合血浆置换、输注去白红细胞治疗AIHA的效果显著,可降低输血反应发生率,且安全性高。

Objective To investigate the effect of rituximab combined with plasma exchange and infusion of leukocytedepleted red blood cells in the treatment of autoimmune hemolytic anemia(AIHA).Methods A total of 68 AIHA patients admitted in our hospital were selected and divided into control group(34 cases,plasma exchange+infusion of leukocytedepleted red blood cells)and observation group(34 cases,rituximab+plasma exchange+infusion of leukocyte-depleted red blood cells)according to the single-blind method.The therapeutic effect,blood routine indexes,adverse reactions,transfusion reactions and cytokines were compared between the two groups.Results There were no significant differences in the total effective rate of treatment and the total incidence of adverse reactions between the two groups(P>0.05).After 4 weeks of treatment,TBIL level in the observation group was significantly lower than that in the control group,RBC and Hb level were significantly higher than those in the control group(P<0.05).The total incidence of transfusion reaction in the observation group was significantly lower than that in the control group(P<0.05).After 1 d,2 weeks and 4 weeks of treatment,the levels of IFN-γand IL-12 in the observation group were significantly lower than those in the control group,and the levels of IL-10 in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Rituximab combined with plasma exchange and infusion of leukocyte-depleted red blood cells in the treatment of AIHA has a significant effect,which can reduce the incidence of transfusion reactions and has high safety.