利妥昔单抗对弥漫大B细胞淋巴瘤患者免疫学指标、近期疗效的影响观察

INFLUENCE OF RITUXIMAB ON IMMUNOLOGICAL INDICATORS AND SHORT-TERM EFFECTS IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA

目的探究利妥昔单抗对弥漫大B细胞淋巴瘤(DLBCL)患者免疫学指标及近期疗效的影响。方法选取2019年9月—2020年7月该院收治的DLBCL患者178例,采用随机数字表法进行分组,将患者分为观察组(n=93)和对照组(n=85)。对照组患者接受环磷酰胺^(+)阿霉素^(+)长春新碱^(+)泼尼松(CHOP)化疗方案进行治疗,观察组患者在此基础上加用利妥昔单抗治疗,比较二组患者的近期疗效、不良反应发生情况和免疫学指标变化。结果观察组治疗客观有效率(ORR)为84.95%,高于对照组的64.71%(P<0.05);治疗期间,二组患者均出现一定的不良反应,便秘、恶心呕吐、感染、发热和WBC下降发生率比较,差异均无统计学意义(P>0.05);化疗后,观察组的CD3^(+)水平均较化疗前下降,差异有统计学意义(P<0.05),CD4^(+)和CD4^(+)/CD8^(+)水平无明显变化,差异无统计学意义(P>0.05),且观察组的CD3^(+)水平低于对照组,差异有统计学意义(P<0.05),对照组的T淋巴细胞水平均较化疗前无明显变化,差异无统计学意义(P>0.05);化疗后,观察组患者的IgG、IgA和IgM水平均较化疗前下降,差异有统计学意义(P<0.05),且观察组的IgG、IgA和IgM水平低于对照组,对照组的免疫球蛋白水平均较化疗前无明显变化(P>0.05),差异无统计学意义。结论利妥昔单抗联合CHOP化疗方案在治疗DLBCL方面疗效确切,可明显提高患者近期疗效,安全性较高,但会对患者的免疫球蛋白水平造成一定影响,临床在应用利妥昔单抗时应实时监控患者T淋巴细胞亚群和免疫球蛋白水平变化。

Objective To explore the influence of rituximab on immunological indicators and short-term effects in patients with diffuse large B-cell lymphoma(DLBCL).Methods A total of one hundred and seventy-eight patients with DLBCL who were treated in our hospital from September 2019 to July 2020 were selected and using the toss of a coinrandomly divided into 2 groups: observation group(n=93) and control group(n=85).The control group were treated with cyclophosphamide + adriamycin + vincristine + prednisone(CHOP) chemotherapy regimen, while the observation group were treated with rituximab on this basis.The short-term effects, occurrence of adverse reactions and changes in immunological indicators were compared between the 2 groups.Results The objective response rate(ORR) in the observation group was 84.95%,higher than 64.71% in the control group, the difference were statistically significant(P<0.05).Adverse reactions were observed in both groups during treatment, and no significant differences were found in the incidences of constipation, nauseaand vomiting, infection, fever, anddecreased WBC between the 2 groups, there was no statistically significant difference(P>0.05).After chemotherapy, the CD3^(+)level of the observation group decreased, the difference were statistically significant, there was statistically significant difference(P<0.05),while no significant changes in CD4^(+)and CD4^(+)/CD8^(+)were observed, there was no statistically significant difference(P>0.05).Besides, the CD3^(+)level of the observation group was lower than that of the control group, the difference were statistically significant(P<0.05).No significant changes in T lymphocytes were observed in the control group, the difference were no statistically significant(P>0.05).After chemotherapy, the levels of IgG,IgA,and IgM in the observation group decreased, the difference were statistically significant(P<0.05),and were lower than those in the control group.However, no significant changes in immunoglobulin levels were observed in the control group, there was no statistically significant difference(P>0.05).Conclusion Rituximab combined with CHOP chemotherapy has definite effect in the treatment of DLBCL,which can significantly improve the short-term effects, with high safety.However, it will affect the immunoglobulin levels to a certain extent.Therefore, changes in T lymphocyte subsets and immunoglobulin levels should be monitored in real time while using rituximab for treatment.