目的 探讨阿法骨化醇联合小剂量利妥昔单抗治疗成人持续性原发免疫性血小板减少症（ITP）的临床疗效以及其对患者外周血树突状细胞（DC）亚群和血清辅助性T细胞（Th）1/Th2相关细胞因子、白细胞介素（IL）-17、1，25-双羟维生素D₃［1，25（OH）₂D₃］水平的影响。方法 回顾性选择北京航天总医院2019年1月—2021年12月收治的92例成人持续性ITP患者为研究对象，根据治疗方法的不同分成试验组46例与对照组46例。对照组给予小剂量利妥昔单抗注射液静脉输注治疗，每次100 mg，每次30 min，每周1次，共4次。试验组在对照组基础上联合给予阿法骨化醇胶囊口服治疗，每次1粒，每天1次。两组均连续治疗4周。比较两组临床疗效。分别于治疗前后检测两组患者外周血DC亚群［浆细胞样树突状细胞（pDC）、髓样树突状细胞（mDC）］，血清Th1/Th2相关细胞因子［IL-2、γ干扰素（IFN-γ）、IL-4、IL-10］，血清IL-17、1，25（OH）₂D₃水平。统计两组不良反应发生情况。结果 试验组总有效率为82.61%，与对照组的63.04%相比显著升高（P<0.05）。两组治疗后外周血mDC占比均较本组治疗前显著降低（P<0.05），外周血pDC占比均较本组治疗前显著升高（P<0.05）；且均以试验组的改善更显著（P<0.05）。两组治疗后血清IL-2、IFN-γ水平均较本组治疗前显著降低（P<0.05），血清IL-4、IL-10水平均较本组治疗前显著升高（P<0.05）；且治疗后，试验组血清IL-2、IFN-γ水平均显著低于对照组（P<0.05），血清IL-4、IL-10水平均显著高于对照组（P<0.05）。两组治疗后血清IL-17水平均较本组治疗前显著降低（P<0.05），血清1，25（OH）₂D₃水平均较本组治疗前显著升高（P<0.05）；且治疗后，试验组血清IL-17水平显著低于对照组（P<0.05），血清1，25（OH）₂D₃水平显著高于对照组（P<0.05）。试验组不良反应总发生率（19.57%）与对照组（17.39%）比较，差异无统计学意义（P>0.05）。结论 阿法骨化醇联合小剂量利妥昔单抗治疗成人持续性ITP能有效调节患者外周血DC亚群和血清Th1/Th2细胞因子、IL-17、1，25（OH）₂D₃水平，提高临床疗效，且安全性较好。

Objective To investigate the clinical efficacy of alfacalcitol combined with low-dose rituximab in treatment of persistent primary immune thrombocytopenia (ITP) in adults and its effects on peripheral blood dendritic cell (DC) subsets and serum helper T cell (Th) 1/Th2cytokines, interleukin (IL-17) and 1, 25-dihydroxyvitamin D₃[1, 25(OH)₂D₃] levels. Methods A total of 92 adult patients with persistent ITP admitted to Beijing Aerospace General Hospital from January 2019 to December 2021 were selected as the study subjects, and they were divided into experimental group (n=46) and control group (n=46) according to the different treatment methods. Patients in the control group were treated with intravenous infusion of low dose of Rituximab Injection, 100 mg each time, and infusion for 30 min each time, once a week, four times in total. On the basis of the control group, patients in the experimental group were given Alfacalciferol Capsules orally, one capsule each time, once a day. Patients in both groups were treated continuously for four weeks. The clinical theraputic efficacy of the two groups was compared after treatment. Peripheral blood DC subsets[plasmacytoid dendritic cells (pDC), myeloid dendritic cells (mDC)], serum Th1/Th2 cytokines[IL-2, γ -interferon (IFN- γ), IL-4, IL-10] and serum IL-17, 1, 25(OH)₂D₃ were detected before and after treatment. The adverse reactions of the two groups were recorded. Results The total effective rate of experimental group was 82.61%, significantly higher than that of control group (63.04%, P<0.05). After treatment, the percentage of mDC in peripheral blood of two groups were significantly decreased (P<0.05), and the percentage of pDC in peripheral blood was significantly increased (P<0.05). The improvement in experimental group was more significant (P<0.05). After treatment, the levels of serum IL-2 and IFN- γ in two groups were significantly decreased compared with before treatment (P<0.05), and the concentrations of serum IL-4 and IL-10 in two groups were significantly increased compared with before treatment (P<0.05). After treatment, the levels of serum IL-2 and IFN- γ in experimental group were significantly lower than those in control group (P<0.05), and the contents of serum IL-4 and IL-10 in experimental group were significantly higher than those in control group (P<0.05). After treatment, the serum IL-17 level in two groups were significantly decreased (P<0.05), and the serum 1, 25(OH)₂D₃ content in two groups were significantly increased (P<0.05). After treatment, serum IL-17 level in experimental group was significantly lower than that in control group (P<0.05), and serum 1, 25(OH)₂D₃ concentration in experimental group was significantly higher than that in control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the experimental group (19.57%) and the control group(17.39%, P>0.05). Conclusion Alfacalccitol combined with low-dose rituximab can effectively regulate peripheral blood DC subsets and serum Th1/Th2 cytokines, IL-17, 1, 25(OH)₂D₃ levels in treatment of adult persistent ITP, and improve clinical efficacy with good safety.

R973

航天医科医疗项目（2020YK23）