低剂量利妥昔单抗治疗成人激素依赖微小病变肾病综合征的疗效  

Therapeutic efficacy of low-dose rituximab for steroid-dependent minimal-change nephrotic syndrome in adults

作　　者：李小伟[1] 郭凯琦 徐丽[1] 黄兰兰 李慧敏 Li Xiao-wei;Guo Kai-qi;Xu Li;Huang Lan-lan;Li Hui-min(Department of Nephrology,Affiliated Municipal People's Hospital,Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学附属阜阳人民医院(阜阳市人民医院)肾内科,236000

出　　处：《临床肾脏病杂志》2021年第9期727-732,共6页Journal Of Clinical Nephrology

基　　金：阜阳市第六批产业创新团队项目,2019蚌埠医学院自然科学重点项目(BYKT2019228ZD)。

摘　　要：目的观察低剂量利妥昔单抗(rituximab,RTX)预防成人激素依赖微小病变肾病综合征(steroid-dependent minimal change nephritic syndrome,SDMCNS)复发的疗效。方法回顾性分析2018年11月至2019年12月我院收治且随访时间大于18个月的接受低剂量RTX治疗的8例SDMCNS患者临床检验资料。结果(1)8例患者应用RTX时中位年龄28.5(18~53)岁,在中位24.5(18~28)个月随访中分别有5例、3例间歇使用RTX 0.375 g/m 22剂、3剂。(2)所有患者一年内无复发,其中4例监测CD19+B细胞数增加至绝对值大于6个/μL时重复使用RTX 0.375 g/m 2的SDMCNS患者,至随访期末复发。(3)对比RTX治疗前后一年临床资料发现,8例患者经RTX治疗后激素应用量减少,随访期末维持7.5(0~20)mg/d,其中2例患者停用激素,且复发次数、住院次数及并发症均显著减少。(4)8例患者应用RTX后,除1例患者出现皮疹及皮肤瘙痒外,其余患者无明显不良反应。结论低剂量RTX治疗成人SDMCNS,在监测CD19+B细胞数基础上重复使用RTX,可减少复发同时减少经济支出,且不良反应少。Objective To explore the therapeutic efficacy of low-dose rituximab(RTX)for a relapse of steroid-dependent minimal-change nephrotic syndrome(SDMCNS)in adults.Methods From November 2018 to December 2019,8 male SDMCNS patients were retrospectively analyzed.They received low-dose RTX treatment and were followed up for over 18 months.Results The median age was 28.5(18-53)years and the median follow-up period 24.5(18-28)months.And 5 and 3 cases received 2 and 3 intermittent doses of RTX 0.375 g/m 2 respectively.None of them had a relapse within 1 year.RTX 0.375 g/m 2 was repeated for 4 cases when CD19+B-cell count dropped to 6.No relapse occurred at the end of follow-up period.A comparison of clinical data at 1 year before and after RTX dosing,hormone dose declined.At the end of follow-up period,the maintenance dose was 7.5(0-20)mg/d.Two discontinued horome and frequency of relapse/hospitalization and incidence of complications decreased markedly.Except for skin rash and pruritus in one case,the remainders had no obvious adverse effects.Conclusion For SDMCNS in adults,using low-dose RTX may be repeated based upon monitoring CD19+B-cell count.Such a regimen may lower the frequency of relapse and reduce economic expenditures with fewer side effects.

关 键 词：成人 激素依赖型肾病综合征 微小病变 低剂量利妥昔单抗 

分 类 号：R692[医药卫生—泌尿科学]