92例初诊1型糖尿病行利妥昔单抗免疫治疗患者的不良反应及护理对策

摘要

Objective To analyze the influencing factors of adverse reaction(ADR)in newly diagnosed type 1 diabetes mellitus(T1DM)patients with rituximab treatment,and explore effective nursing strategies. Methods By retrospectively analyzing the clinical data of 92 newly diagnosed T1DM patients with rituximab treatment,occurrence characteristics of ADR were analyzed. Influencing factors were analyzed by univariate and binary logistic regression analysis.Results Among 92 patients,adverse reactions occurred in 41 cases(44.6%). Univariate analysis showed incidence rate of ADR were:age <18 year-old vs. ≥18 year-old(54.0% vs. 33.3%, P<0.05);male vs. female(37.7% vs. 53.8%,P>0.05);normal BMI vs. abnormal BMI(41.8% vs. 48.6%,P>0.05);duration ≤6 months vs. > 6 months and ≤ 1 year(44.44% vs. 45.5%,P>0.05);with a medical history of autoimmune diseases vs. without(31.4% vs. 61.9%,P>0.05);with a history of allergy vs. without(37.5% vs. 45.2%,P>0.05). Binary logistic regression showed that influencing factors of ADR were:age(OR= 0.353,P<0.05) and with a history of autoimmune diseases(OR=3.938,P<0.05).Conclusions Occurrence of ADR in newly diagnosed T1DM treated with rituximab is associated with age and history of autoimmune diseases. Clinical caring nurses should strengthen the risk assessment of this kind of patients,to ensure successful implementation of therapeutic schedule.%目的 分析初诊1型糖尿病行利妥昔单抗治疗不良反应发生的影响因素,探讨有效护理对策.方法 回顾性分析92例初诊1型糖尿病行利妥昔单抗治疗患者的临床资料,统计不良反应的发生特点,采用单因素和二元Logistic回归分析影响因素.结果 92例患者中41例出现不良反应(44.6%).单因素结果显示不良反应发生率:年龄<18岁vs≥18岁(54.0%vs 33.3%,P<0.05);男性vs女性(37.7%vs 53.8%,P>0.05);BMI正常vs不正常(41.8%vs 48.6%,P>0.05);病程≤6个月vs>6个月至≤1年(44.44%vs 45.5%,P>0.05);自身免疫性疾病史有vs无(61.9%vs 39.4%,P>0.05);过敏史有vs无(37.5%vs 45.2%,P>0.05).二元Logistic回归分析结果显示:年龄(OR=0.353,P<0.05)和自身免疫性疾病史(OR=3.938,P<0.05)为不良反应发生的影响因素.结论 初诊1型糖尿病行利妥昔单抗治疗不良反应的发生与年龄、有自身免疫性疾病史有关.临床上护士要加强此类患者的护理风险评估,以保证治疗方案的顺利实施.