利妥昔单抗联合糖皮质激素治疗难治性大疱性皮肤病临床分析  

Rituximab in combination with corticosteroid in the treatment of 14 patients with refractory bullous diseases

作　　者：邱于芳[1] 钟珊[1] 王佩茹[1] 朱学骏[1] 陈喜雪[1] 

机构地区：[1]北京大学第一医院皮肤科,北京100034

出　　处：《临床皮肤科杂志》2011年第9期536-539,共4页Journal of Clinical Dermatology

摘　　要：目的:观察利妥昔单抗(联合糖皮质激素)治疗难治性大疱性皮肤病的临床疗效及不良反应。方法:14例确诊的难治性大疱性皮肤病(8例寻常型天疱疮、3例大疱性类天疱疮、2例获得性大疱性表皮松解症、1例红斑型天疱疮)患者,按体表面积375 mg/m^2静脉滴注利妥昔单抗,每周1次,共4次(第1、8、15、22天)。治疗前均做血、尿常规,肝、肾功能,血脂,血糖,电解质,免疫球蛋白,血清疱病特异抗体及外周血流式细胞仪CD3、CD19、CD20细胞计数等检查,并在治疗中以及治疗结束后定期复查。结果:14例患者中11例完全缓解,3例部分缓解。完全缓解的11例患者中,2例已完全停药;其余患者糖皮质激素逐渐减量中。3例部分缓解患者,皆已停用所有药物,皮损仅在外力碰撞后出现。出现2例复发病例;还有1例在治疗后3个月因肺部感染死亡。结论:利妥昔单抗(联合糖皮质激素)治疗难治性大疱性皮肤病有明确的疗效,且不良反应较少。Objective： To assess the efficacy and safety of rituximab in the treatment of refractory bullous diseases. Methods： Fourteen patients （8 PV, 3 BP, 2 EBA and 1 PE） with refractory bullous disease were treated with four weekly infusions of 375 mg of rituximab per square meter of body-surface area in combination with corticosteroid. Routine examination of blood and urine, liver and renal function, blood fipids, blood glucose, electrolytes, immunoglobulin, specific antibodies of bullous diseases and peripheral blood B- and T-lymphocyte subpopulations were examined before treatment,during treatment and after treatment. Results： Eleven of the 14 patients had a complete remission and three had a partial remission. Of the eleven patients who had a complete remission, two patients had a relapse 9 and 8 months after treatment respectively; one patient died of pneumonia 3 months after treatment; the remainder＇s condition was stable, two of them stop any therapy now. Three of partial remission patients were not receiving any drug and new rashes only occurred after scratching. Conclusions： Rituximab is an effective and safe treatment for refractory bullous diseases. Larger series with a longer follow-up are needed to assess the long-term effects and risks of this treatment.

关 键 词：利妥昔单抗:大疱性皮肤病 治疗 

分 类 号：R758.66[医药卫生—皮肤病学与性病学]