CAJ | 학술논문

目的评价小剂量利妥昔单抗治疗儿童原发免疫性血小板减少症(ITP)的疗效和安全性.方法 2009年1月至2013年1月应用小剂量利妥昔单抗(375 mg/m2×1次)治疗50例持续性和慢性儿童ITP患者,观察疗效和不良反应并分析影响疗效的相关因素.结果 50例患儿中,男23例,女27例,中位年龄9.5(3.5～17.0)岁.32例(64％)获得治疗反应,其中17例(34％)为完全反应(CR),15例(30％)为有效(R).获CR患者PLT持续＞50×109/L的中位时间为12.3 (6.0～40.0)个月,获R患者PLT持续＞30×109/L的中位时间为6.0(2.0～12.0)个月.治疗后3、6个月总反应(CR+R)率分别为58％、64％.6例患儿出现荨麻疹、发热等轻微不良反应.患儿性别、年龄、病程、治疗前PLT、CD19+B细胞数量均与疗效无相关性(P＞0.05).血小板膜糖蛋白GPⅡb/Ⅲa抗体阳性患者有较高的总反应率(P＜0.05).结论小剂量利妥昔单抗治疗持续性和慢性儿童ITP疗效、耐受性均较好;血小板膜糖蛋白GPⅡb/Ⅲa抗体阳性患者疗效较好.
목적 평개소제량리타석단항치료인동원발면역성혈소판감소증(ITP)적료효화안전성.방법 2009년1월지2013년1월응용소제량리타석단항(375 mg/m2×1차)치료50례지속성화만성인동ITP환자,관찰료효화불량반응병분석영향료효적상관인소.결과 50례환인중,남23례,녀27례,중위년령9.5(3.5～17.0)세.32례(64％)획득치료반응,기중17례(34％)위완전반응(CR),15례(30％)위유효(R).획CR환자PLT지속＞50×109/L적중위시간위12.3 (6.0～40.0)개월,획R환자PLT지속＞30×109/L적중위시간위6.0(2.0～12.0)개월.치료후3、6개월총반응(CR+R)솔분별위58％、64％.6례환인출현담마진、발열등경미불량반응.환인성별、년령、병정、치료전PLT、CD19+B세포수량균여료효무상관성(P＞0.05).혈소판막당단백GPⅡb/Ⅲa항체양성환자유교고적총반응솔(P＜0.05).결론 소제량리타석단항치료지속성화만성인동ITP료효、내수성균교호;혈소판막당단백GPⅡb/Ⅲa항체양성환자료효교호.
Objective To evaluate the efficacy and safety of lower doses rituximab(375 mg/m2× 1) in primary children immune thrombocytopenia (ITP).Methods Fifty children [23 male and 27 female,the median age was 9.5 years (rage 3.5-17.0 years)] with persistent and chronic ITP were treated with lower doses rituximab from January 2009 to January 2013 in our hospital.Efficacy and side effects of lower doses rituximab was studied,and factors related to the outcomes were analyzed.Results Among fifty patients,17/50(34％) achieved a complete response (CR) and 15/50 (30％) patients got response (R).Patients with CR continued to maintain a platelet count above 50× 109/L at a median 12.3 (6-40) months.Patents with R continued to maintain a platelet count above 30× 109/L at a median 6 (2-12) months.The overall response (OR) in 3 and 6 months were 58％ (29/50),64％ (32/50) respectively.Six patients have mild and transient side effects,including urticarial rash and fever,which were promptly resolved with appropriate therapy.Sex,age at diagnosis,interval from diagnosis to initial treatment with rituximab,platelet count at treatment and CD19+B cell count did not in fl uence the overall response and complete response (P＞0.05).Patients with anti-GP Ⅱ b/Ⅲ a autoantibody had a better OR (P＜0.05).Conclusion Children with persistent and chronic ITP treated by lower doses rituximab had better therapeutic effects.Patients with anti-GP Ⅱ b/Ⅲ a autoantibody had better response.Rituximab was well tolerated and no related serious side effects were recorded in the study.