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目的 探讨血小板计数水平在成人慢性原发免疫性血小板减少症(ITP)患者利妥昔单抗疗效预测中的价值.方法 回顾性分析2011年1月1日至2014年12月31日期间接受利妥昔单抗治疗(100 mg每周1次,连用4次)慢性ITP患者的临床资料,计算利妥昔单抗治疗后不同随访时间截点血小板计数预测疗效的敏感性、特异性和阳性预测值、阴性预测值,并通过ROC曲线下面积得出最佳截断点.结果 103例患者纳入研究,男46例,女57例,中位年龄30(18～67)岁.首剂利妥昔单抗后第1、5、7天,成功组(治疗后PLT≥50×109/L且未接受其他药物治疗)与无效组(治疗后PLT＜ 50×109/L)中位血小板计数差异均无统计学意义(P＞0.05);利妥昔单抗治疗后第14天,成功组中位血小板计数高于无效组[41(8～ 384)×109/L对23(0～ 106)×109/L,P=0.003];在随后的各随访截点,成功组中位血小板计数进一步回升并维持于正常水平,无效组中位血小板计数均低于正常水平.以ROC曲线获得的预测治疗反应的优化界限值血小板计数50× 109/L为基础,首剂妥昔单抗治疗后第14、30、60天血小板计数能够组成一个预后评估体系.结论 利妥昔单抗治疗后第14、30、60天血小板计数能够组成一个疗效预测评估体系,有助于随访和制定治疗计划.

Objective To investigate the value of platelet count in predicting the efficacy of rituximab treatment in chronic primary immune thrombocytopenia (ITP).Methods A retrospective study was conducted in 103 chronic ITP patients hospitalized in our medical center between January 2011 and December 2014.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) of platelet count in different time points were analyzed for the predictor of treatment response.Optimal cutoff values were established using ROC analysis.Results A total of 103 patients were included in the study.There were 46 males and 57 females,with a median age of 30 (18-67) years.At day 1,3 and 7 after the first dose of rituximab,there was no significant difference in platelet counts between the success group (PLT≥50× 109/L after treatment) and the failure group (PLT≤50× 109/L after treatment) (P＞ 0.05).At day 14 after rituximab treatment (PTD 14),platelet counts became significantly different in the success and failure groups [41(8-384) × 109/L vs 23(0-106) × 109/L,P =0.003],and remained different thereafter,with increasing significance in the subsequent follow-ups.Patients were divided further using an optimal cut-off platelet count of 50× 109/L on PTD 14,PTD 30,and PTD 60,and PPV and NPV values were calculated for predicting eventual success and failure.Conclusion Response can be predicted by obtaining platelet counts at 14,30 and 60 days after rituximab treatment.The study proposed a protocol that guides patient monitoring and management planning.