小剂量利妥昔单抗对难治性免疫性血小板减少症患者凝血功能及预后的影响

Effect of Low dose Rituximab on Coagulation Function and Prognosis in Patients with Refractory Immune Thrombocytopenia

目的研究小剂量利妥昔单抗对难治性免疫性血小板减少症(r ITP)患者凝血功能及预后的影响。方法选取我院2010年12月至2014年12月r ITP患者78例,抽签随机分为观察组和对照组两组,每组39例,对照组患者给予常规剂量利妥昔单抗375 mg/m^2,观察组患者给予小剂量利妥昔单抗100 mg/m^2,比较两组患者临床疗效、复发率,治疗前后血小板计数(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(a PTT)变化情况,血清免疫球蛋白Ig A、Ig M、Ig G和淋巴细胞CD3^+、CD4^+的水平变化及不良反应发生率。结果观察组治疗有效率为64.10%、复发率为5.13%与对照组比较53.85%、7.69%无统计学意义(P>0.05);与治疗前比较两组患者的PLT水平较治疗前显著较高(P<0.05),PT、a PTT水平较治疗前显著较低(P<0.05);观察组Ig M水平较对照组显著较低(P<0.05),Ig A、Ig G、CD3^+、CD4^+水平较对照组显著较高(P<0.05);观察组患者的不良反应发生率为10.26%较对照组28.21%显著较低(P<0.05)。结论常规剂量和小剂量利妥昔单抗治疗r ITP患者均有显著疗效,复发率低,有利于凝血功能的恢复,小剂量给予利妥昔单抗治疗安全性更高。

Objective To study the low-dose rituximab function and prognosis of refractory immune thrombocytopenia( r ITP) in patients with clotting. Methods in our hospital from December 2010 to December2014 r ITP 78 patients,randomized into two groups by drawing lots and control group,39 patients in the control group of patients in each group received conventional dose of rituximab 37 mg / m^2 observation group were treated with low-dose rituximab 100 mg / m^2,the clinical efficacy of two groups were compared,the relapse rate after treatment platelet count( PLT),prothrombin time( PT),partial thromboplastin time( a PTT) changes,serum immunoglobulin Ig A,Ig M,Ig G and lymphocytes CD3 +,CD4 + levels and the incidence of adverse reactions. Results There were a therapeutically effective rate was 64. 10%,the recurrence rate was 5. 13%compared with control group 53. 85%,7. 69% was not statistically significant( P > 0. 05); significantly higher pre-treatment before and PLT levels were compared in patients than treatment( P < 0. 05),PT,former a PTT levels than before treatment was significantly lower( P < 0. 05); the observation group Ig M levels compared with the control group was significantly lower( P < 0. 05),Ig A,Ig G,CD3 +,CD4 + levels than the control group significantly higher( P < 0. 05); the incidence of adverse reactions observed group of patients was10. 26% compared with 28. 21% in the control group was significantly lower( P < 0. 05). Conclusion The conventional dose and low-dose rituximab treatment r ITP patients had a significant effect,low recurrence rate,is conducive to the recovery of coagulation,small doses of rituximab greater treatment safety.