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目的观察利妥昔单抗联合输血治疗自身免疫性溶血性贫血的临床疗效及安全性。方法将80例自身免疫性溶血性贫血患者随机分为对照组40例和试验组40例。对照组予以口服叶酸5 mg·d~(-1)+0.75~1.00 mg·kg~(-1)·d~(-1)泼尼松,每天1次,连续服用2周后泼尼松减量至0.75 mg·kg~(-1)·d~(-1),持续服用到第3周再减量至0.5 mg·kg~(-1)·d~(-1),持续服用1周。试验组予以静脉滴注375 mg·m~(-2)利妥昔单抗,每周一次,同时输血100～200 m L,每天1次。2组患者均治疗4周。比较2组患者的临床疗效和不良反应发生率。结果治疗后,试验组的总有效率为97.50%显著高于对照组的47.50%(P<0.05)。对照组未出现不良反应的情况,试验组出现1例过敏反应的患者,但暂停利妥昔单抗后,不良反应症状消失。2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论利妥昔单抗联合输血治疗自身免疫性血溶性贫血可显著提高临床疗效,且不增加不良反应的发生率。
Objective To observe the clinical efficacy and safety of rituximab combined with transfusion in the treatment of autoimmune hemolytic anemia. Methods Eighty patients with autoimmune hemolytic anemia were randomly divided into control group (40 cases) and experimental group (40 cases). The control group was given oral folic acid 5 mg · d -1 0.75 ~ 1.00 mg · kg -1 d -1 prednisone once a day for 2 weeks after continuous administration of prednisone The dosage was reduced to 0.75 mg · kg -1 · d -1 and then decreased to 0.5 mg · kg -1 · d -1 for the third week and continued for 1 week . The experimental group received intravenous infusion of 375 mg · m -2 rituximab once a week while transfused 100-200 m L once daily. Two groups of patients were treated for 4 weeks. The clinical efficacy and incidence of adverse reactions in two groups were compared. Results After treatment, the total effective rate of the experimental group was 97.50%, significantly higher than that of the control group (47.50%, P <0.05). In the control group, there was no adverse reaction. One patient with allergic reaction appeared in the test group. However, the symptoms of adverse reactions disappeared after the suspension of rituximab. There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Rituximab combined with transfusion in the treatment of autoimmune hemolytic anemia can significantly improve the clinical efficacy, and does not increase the incidence of adverse reactions.