利妥昔单抗或他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效比较  

A retrospective study of rituximab or Tacrolimus combined with glucocorticoid for idiopathic membranous nephropathy

作　　者：刘纯玲 王述蔷 耿晓东[1] 郭满地 洪权[1] 吴镝[1] LIU Chun-ling;WANG Shu-qiang;GENG Xiao-dong;GUO Man-di;HONG Quan;WU Di(Department of Nephrology, Chinese PLA General Hospital, Beijing, 100835, China)

机构地区：[1]中国人民解放军总医院肾内科

出　　处：《临床肾脏病杂志》2019年第6期421-425,共5页Journal Of Clinical Nephrology

摘　　要：目的比较利妥昔单抗或他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效及安全性。方法选取中间人民解放军总医院肾内科2014年3月至2018年3月分别使用利妥昔单抗联合小剂量激素(利妥昔单抗组)和他克莫司联合小剂量激素(他克莫司组)治疗的特发性膜性肾病患者。观察2组患者在治疗前、治疗1个月、3个月、6个月、12个月的24h尿蛋白定量、血清白蛋白、肌酐水平的变化,评估治疗总体有效率,观察不良反应发生情况。结果共纳入研究对象149例,其中利妥昔单抗组62例,他克莫司组87例,2组患者治疗前在年龄、性别、24h尿蛋白定量、血清白蛋白、血肌酐等方面均无显著性差异(P>0.05)。治疗12个月后,利妥昔单抗组的总有效率(70.97%)与他克莫司组(64.37%)相比,差异无统计学意义(P>0.05),但利妥昔单抗组复发率远低于他克莫司组(P<0.01)。2组患者治疗后24h尿蛋白水平较治疗前均有效降低(P<0.01),血清白蛋白水平较治疗前均有所提升(P<0.01),且2组对24h尿蛋白和血清白蛋白水平的改善效果相近,差异无统计学意义(P>0.05);而在血肌酐变化方面,利妥昔单抗组患者治疗后较治疗前无显著差异(P>0.05),总体肾功能稳定,他克莫司组患者治疗后血肌酐较治疗前有所上升(P<0.01),提示出现肾功能损害。在不良反应方面,利妥昔单抗组主要表现为感染、输注反应,他克莫司组则表现为感染、肝肾功能损害、血糖升高、胃肠道反应、脱发等,利妥昔单抗组的不良反应类型和出现不良反应的人数更少。结论利妥昔单抗与他克莫司均能有效缓解特发性膜性肾病,降低蛋白尿,但与他克莫司比较,利妥昔单抗具有不良反应低、复发率低、更经济便利的优点,有望成为一线治疗药物。Objective To compare the efficacy and safety of rituximab or tacrolimus combined with glucocorticoid for treatment of idiopathic membranous nephropathy. Methods The patients with idiopathic membranous nephropathy treated with rituximab combined with low-dose hormone (rituximab group) and tacrolimus combined with low-dose glucocorticoid (tacrolimus group) respectively in Department of Nephropathy of Chinese PLA General Hospital from March 2014 to March 2018 were selected. The changes of 24-hour urinary protein content, serum albumin and creatinine levels in the two groups before treatment, and at 1 month, 3 months, 6 months and 12 months of treatment were observed to assess the total remission rate. Adverse reactions were observed. Results A total of 149 subjects were included in the study, including 62 patients in the rituximab group and 87 patients in tacrolimus group. There were no significant differences in age, gender, 24 h urine protein content, serum albumin and serum creatinine before treatment between the two groups ( P >0.05).After 12 months of treatment, the total remission rate with the rituximab group (70.97%) was not significantly different from that with the tacrolimus group (64.37%)( P >0.05), but the recurrence rate with the rituximab group was much lower than that with the tacrolimus group ( P <0.01). The 24-hour urine protein of the two groups was significantly lower than that before treatment ( P <0.01). Serum albumin levels all were improved compared with those before treatment( P <0.01), and the improvement rates of 24 h urine protein content and serum albumin level in the two groups were similar with no statistically significant difference ( P >0.05). In term of changes of serum creatinine, there was no significant difference compared with that before treatment in the rituximab group ( P >0.05), with the overall stable kidney function. In the tacrolimus group, serum creatinine after treatment increased compared with that before treatment, suggesting damage of renal functions, In terms of adv

关 键 词：膜性肾病 利妥昔单抗 他克莫司 糖皮质激素 不良反应 

分 类 号：R692[医药卫生—泌尿科学]