摘要
将我院儿童难治性特发性血小板减少性紫癜（RITP）患儿50例按治疗方法分成2组：利妥昔单抗组（26例，给予标准剂量利妥昔单抗治疗）和长春新碱组（24例，给予长春新碱治疗）。另选择同期于我院体检的健康儿童20例为正常对照组。治疗结束后，对比两组患儿疗效、药物不良反应，随访两组患儿复发的情况；应用流式细胞术测定利妥昔单抗组RITP患儿治疗前后外周血CD19^＋／CD20^＋B细胞的表达水平变化并与正常对照组比较。结果提示，利妥昔单抗组总有效率明显高于长春新碱组（69．2％比37．5％，χ^2=9．74，P〈0．01）；两组的不良反应发生率比较差异无统计学意义（11．5％比8．3％，χ^2=0．62，P〉0．05）。随访利妥昔单抗组治疗有效患儿复发率（22．2％）明显低于长春新碱组（55．6％），两组比较差异具有统计学意义（χ^2=7．24，P〈0．05）。利妥昔单抗治疗有效患儿外周血小板数量达（106．7±32．5）×10^9／L，较治疗前明显升高（t=12．48，P〈0．01）；外周血CD19^＋／CD20^＋B细胞表达明显较治疗前降低（t=6．71，P〈0．05）。提示利妥昔单抗可能是通过耗竭B细胞而发挥其作用，对RITP患儿具有较满意的疗效，无严重的不良反应。
Fifty children with refractory idiopathic thrombocytopenic purpura （RITP） were treated with rituximab （ n = 26） or vincristine （ n = 24）. The response rate, adverse reaction and recurrence rate in two groups were compared. The CD19 ^＋/CD20^＋ B cells in peripheral blood were detected by flow cytometry in 26 patients before and after RITP treatment. The response rates of rituximab group was significantly higher than that of vincristine group （69. 2% vs. 37.5% , χ2 = 9. 74, P 〈 0. 01 ）. There was no significant difference in the rate of adverse reaction between two groups （ 11.5% vs. 8.3% χ2 =0. 62, P 〉0. 05）. The recurrence rate of rituximab group （22. 2% ） was significantly lower than that of vincristine group （55.6% ,χ^2 = 7. 24, P 〈 0. 05 ）. In rituximab group the platelet count after treatment was significantly higher than that before treatment （t = 12. 48, P 〈 0. 01 ）, and the ratio of CD19 ^＋/CD20 ^＋B cells decreased significantly after treatment compare to that before treatment （t = 6. 71, P 〈 0. 05 ）. Rituximab is effective in treatment of refractory idiopathic thrombocytopenic purpura in children, which may be associated with decreased B cells in peripheral bloos.
出处
《中华全科医师杂志》
2012年第1期67-69,共3页
Chinese Journal of General Practitioners
