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目的:探讨利妥昔单抗联合常规治疗自身免疫性溶血性贫血(AIHA)的临床疗效及对患者血清学特征的影响。方法:88例AIHA患者随机分为观察组和对照组各44例。将观察组再分为温抗体自身免疫性溶血性贫血(WAIHA)和冷凝集素病(CHD)两个亚组。对照组给予口服叶酸、泼尼松,大剂量静注丙种球蛋白等常规治疗;观察组在对照组基础上加用利妥昔单抗,每周静滴1次。两组均连续治疗4周。观察治疗前后观察组各亚组和对照组患者血常规及乳酸脱氢酶、胆红素水平变化,评估临床疗效及药品不良反应。结果:观察组总有效率和完全缓解率均显著高于对照组(P<0.05),复发率显著低于对照组(P<0.05)。WAIHA亚组总有效率和完全缓解率显著高于CHD亚组(P<0.05)。治疗后两组患者血红蛋白、网织红细胞、乳酸脱氢酶、胆红素等指标均较治疗前显著改善(P<0.05),且观察组各项指标均优于对照组(P<0.05)。治疗前,WAIHA亚组血红蛋白、网织红细胞、乳酸脱氢酶、胆红素均显著低于CHD亚组(P<0.05),治疗后WAIHA亚组上述指标改善程度优于CHD亚组(P<0.05)。两组药品不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在传统治疗基础上联合利妥昔单抗治疗AIHA临床效果好,复发率低,且安全性高,对WAIHA效果更佳。
Objective: To investigate the clinical efficacy of rituximab combined with routine treatment of autoimmune hemolytic anemia (AIHA) and its effect on the serological characteristics of patients. Methods: 88 patients with AIHA were randomly divided into observation group and control group, 44 cases each. The observation group was further divided into two subgroups: warm-antibody autoimmune hemolytic anemia (WAIHA) and cold agglutinin-associated disease (CHD). Control group was given oral folic acid, prednisone, high-dose intravenous gamma globulin and other conventional treatment; observation group on the basis of the control group plus rituximab, intravenous infusion once a week. Two groups were treated for 4 weeks. Observed before and after treatment in each subgroup and control group of patients with blood routine and lactate dehydrogenase, bilirubin levels, to assess the clinical efficacy and adverse drug reactions. Results: The total effective rate and complete remission rate in the observation group were significantly higher than those in the control group (P <0.05), and the recurrence rate was significantly lower than that in the control group (P <0.05). The total effective rate and complete remission rate in WAIHA subgroup were significantly higher than those in CHD subgroup (P <0.05). After treatment, the indexes of hemoglobin, reticulocyte, lactate dehydrogenase and bilirubin in both groups were significantly improved (P <0.05), and the indexes in the observation group were better than those in the control group (P <0.05). Before treatment, the hemoglobin, reticulocyte, lactate dehydrogenase and bilirubin in WAIHA subgroup were significantly lower than those in CHD subgroup (P <0.05). After treatment, the above indexes in WAIHA subgroup were better than CHD subgroup (P < 0.05). There was no significant difference between the two groups in the incidence of adverse drug reactions (P> 0.05). Conclusion: The combination of rituximab and rituximab in the treatment of AIHA has good clinical effect, low recurrence rate, high safety and better effect on WAIHA.