利妥昔单抗治疗儿童难治性免疫性脑炎的效果  

Efficacy of rituximab in the treatment of children with refractory immune encephalitis

作　　者：郑宇霞[1] 段丽芬[1] 李亚玲[1] 周玲[1] 潘晓洁[1] 王惠萍[1] ZHENG Yu-xia;DUAN Li-fen;LI Ya-ling;ZHOU Ling;PAN Xiao-jie;WANG Hui-ping(Department of Neurology,Kunming Children's Hospital Kunming,Kunming 650000,China)

机构地区：[1]昆明市儿童医院神经内科,昆明650000

出　　处：《临床药物治疗杂志》2020年第8期18-22,共5页Clinical Medication Journal

基　　金：昆明市科技保障民生发展计划(项目编号:2019-1-S-25318000001445);昆明市卫健委卫生科研课题(项目编号:2020-06-04-114)。

摘　　要：目的分析利妥昔单抗治疗儿童难治性免疫性脑炎的有效性与安全性。方法选择昆明市儿童医院2014年1月至2018年1月儿科收治的102例难治性免疫性脑炎患儿为研究对象,根据随机数字表法将其分为对照组与观察组,每组各51例。对照组继续使用糖皮质激素或大剂量静脉丙种球蛋白(IVIG)一线免疫治疗,而观察组则采用利妥昔单抗实施二线免疫治疗,治疗结束后随访18个月。治疗期间评价并记录2组患儿不良反应发生情况,结合患儿改良Rankin分值(mRs)与复发率评价其临床疗效。结果观察组治疗总有效率为94.12%(48/51),高于对照组的78.43%(40/51),差异有统计学意义(P<0.05);入院时,2组患儿mRs评分比较,差异无统计学意义(P>0.05);治疗结束时、随访各时点,2组患儿mRs评分均较入院时呈下降趋势,且观察组各时点mRs评分低于对照组[治疗结束时,观察组vs.对照组:(3.19±0.62)分vs.(3.65±0.64)分;随访6个月:(2.32±0.39)分vs.(2.70±0.59)分;随访12个月:(2.09±0.41)分vs.(2.61±0.60)分;随访18个月:(2.01±0.24)分vs.(2.43±0.43)分],差异均有统计学意义(P<0.05);2组患儿治疗期间不良反应主要为一过性皮疹、胸闷、头晕、呕吐、腹痛,组间发生率比较差异无统计学意义(P>0.05)。结论利妥昔单抗治疗儿童难治性免疫性脑炎较常规糖皮质激素或大剂量IVIG获益高,神经功能恢复效果好,安全可靠。Objective To analyze the effectiveness and safety of rituximab in the treatment of children with refractory immune encephalitis.Methods Totally 102 children with refractory immune encephalitis admitted in the Pediatrics Department of Kunming Children’s Hospital were selected as the subjects from January 2014 to January 2018,and were divided into control group and observation group according to random number table,with 51 cases in each group.The control group was used first-line immunotherapy with glucocorticoid or high-dose intra venous immune globulin(IVIG).The observation group was treated with rituximab for second-line immunotherapy.After the end of treatment,they were all given follow-up 18 months.After treatment,the adverse reactions,the clinical efficacy,the modified Rankin scale(mRs)and the recurrence rate in the two groups was evaluated.There was no statistical difference in general data between the observation group and the control group(P>0.05).Results The total effective rate of observation group was 94.12%(48/51),which was higher than that of control group 78.43%(40/51),the difference was statistically significant(P<0.05);On admission,there was no statistical difference in the mRs score between two groups(P>0.05);At the end of treatment and at each time of follow-up,the mRs scores of two groups were lower than those on admission,and the mRs scores at different times in observation group were lower than those in control group[at the end of treatment,observation group vs.control group:(3.19±0.62)分vs.(3.65±0.64)分;followed up for 6 months:(2.32±0.39)分vs.(2.70±0.59)分;followed up for 12 months:(2.09±0.41)分vs.(2.61±0.60)分;followed up for 18 months:(2.01±0.24)分vs.(2.43±0.43)分.There were statistical different between the two groups](all P<0.05).There was no statistical difference in the incidence of transient rash,chest distress,dizziness,vomiting,abdominal pain between the two groups during treatment(P>0.05).Conclusion Rituximab in the treatment of children with refractory immune enc

关 键 词：难治性免疫性脑炎 利妥昔单抗 有效性 复发率 

分 类 号：R512.3[医药卫生—内科学]