利妥昔单抗治疗慢性主动脉周围炎:6例及文献复习  

Application of rituximab in treating six patients with chronic periaortitis and literature review

作　　者：廖思敏 赵玉荣 张洁[1] 李坤鹏[1] 邓小虎[1] 王炎焱[1] 张江林[1] 黄烽[1] 朱剑[1] Liao Si-Min;Zhao Yu-Rong;Zhang Jie;Li Kun-Peng;Deng Xiao-Hu;Wang Yan-Yan;Zhang Jiang-Lin;Huang Feng;Zhu Jian(Department of Rheumatology and Immunology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心风湿免疫科,北京100853

出　　处：《解放军医学杂志》2021年第4期380-385,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的报道6例经利妥昔单抗(RTX)治疗的慢性主动脉周围炎(CP)患者的临床特点、诊治经过及预后并进行文献复习,以提高对该病的认识。方法回顾性分析解放军总医院第一医学中心2014年10月-2020年11月收治的6例CP患者应用RTX治疗前后的临床症状、实验室指标、影像学表现变化及不良反应。临床缓解定义为临床症状消失、肾盂积水消失、红细胞沉降率<15 mm/h、C反应蛋白<5 mg/L;完全缓解定义为临床缓解及影像学提示腹膜后包块最大横径缩小50%。检索相关数据库,结合文献报道的58例患者,总结RTX治疗CP的有效性及安全性。结果6例患者均为男性,年龄49.5(42.0~62.0)岁,病程60(30~365)d,随访时间25.7(0.9~66.9)个月。其中3例既往合并严重心血管疾病、1例合并胸主动脉受累。3例应用泼尼松0.25~0.5 mg/(kg·d)联合RTX作为诱导缓解方案,其余3例单用RTX诱导缓解。5例达到临床缓解,其中4例规律应用RTX维持缓解,1例应用小剂量泼尼松维持,中位缓解时间为4.0(0.5~6.0)个月;3例达到完全缓解,中位缓解时间为18(16~24)个月;6例均未出现疾病复发。6例患者未出现输注反应,1例在应用RTX后的第3.5个月出现肺部感染。国内外报道RTX治疗CP共58例,治疗后患者临床症状、实验室指标及影像学表现均有改善,应用RTX后仅5例(8.6%)出现感染,1例(1.7%)死亡,3例(5.2%)复发。结论应用RTX作为诱导缓解及维持缓解方案治疗CP临床效果好,且安全性较高。Objective By literature review to retrospectively study the clinical characteristics,diagnosis and treatment process and prognosis of chronic periaortitis(CP)treated with rituximab(RTX),and to improve the understanding of it.Methods To retrospectively analyze the clinical characteristics,laboratory indicators,changes of imaging findings and adverse reactions before and after RTX treatment of six CP patients admitted in the First Medical Center of Chinese PLA General Hospital from October 2014 to November 2020.The clinical remission was defined as the disappearance of clinical symptoms and hydronephrosis,erythrocyte sedimentation rate(ESR)<15 mm/h and C-reactive protein(CRP)<5 mg/L;complete remission was defined as the clinical remission and the maximum transverse diameter of retroperitoneal mass reduced by 50%.Fifty-eight similar cases were collected by searching the database to investigate the efficacy and safety of RTX in treating patients with CP.Results All the 6 patients were males,aged 49.5(42.0-62.0)years,with pathogenesis of 60(30-365)days and mean follow-up time of 25.7(0.9-66.9)months.Three of the 6 patients had severe cardiovascular disease in the past,one suffered from thoracic aorta involvement.RTX alone was given in 3 patients,and together with prednisone in 3 other patients as induce remission therapy,respectively.Five patients achieved clinical remission,of them one was given small dose of prednisone to maintain long-term remission,the other 4 patients received regular application of RTX to maintain remission.The median remission time was 4.0(0.5-6.0)months.Three patients got complete remission with the median remission time of 18 months(16-24).No recurrence was observed during follow-up.None of the 6 patients had an infusion-related response.One had pulmonary infection at the 3.5-month after the RTX application.A total of 58 cases were found in literature.Clinical symptoms,laboratory tests and imaging findings were all improved.Five(8.6%)patients were infected,1(1.7%)was died and 3(5.2%)had a rec

关 键 词：慢性主动脉周围炎 腹膜后纤维化 利妥昔单抗 

分 类 号：R593.9[医药卫生—内科学]