利妥昔单抗治疗特发性局灶节段肾小球硬化的机制和疗效  

Mechanism and efficacy of rituximab in idiopathic focal segmental glomerulosclerosis

作　　者：闵敏 张炯(综述) 王金泉(审校) MIN Min;ZHANG Jiong;WANG Jinquan(National Clinical Research Center of Kidney Disease,Jinling Hospital,Nanjing Medical University,Nanjing 210016,China)

机构地区：[1]南京医科大学金陵临床医学院(东部战区总医院)国家肾脏疾病临床研究中心、全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2021年第6期575-580,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家重大研发计划(2018YFC1312705)。

摘　　要：局灶节段性肾小球硬化(FSGS)是导致终末期肾病的常见肾小球疾病,足细胞损伤是其发病的主要因素。特发性FSGS的足细胞损伤致病机制仍不详,除糖皮质激素、钙调神经蛋白抑制剂外,目前缺乏有效、特异的治疗方法,易复发,部分患者总体预后差。已有多个文献报道利妥昔单抗在特发性FSGS中有效。作为一种B细胞耗竭剂,利妥昔单抗如何在特发性FSGS患者发挥作用,其免疫学药效和细胞保护作用机制仍在研究和观察中。本文将从利妥昔单抗的药物特点出发,复习近年来主要的临床研究和足细胞损伤治疗领域的主要相关研究报道,就利妥昔单抗治疗特发性FSGS的免疫机制和足细胞保护机制作一综述。Focal segmental glomerulosclerosis(FSGS)is a common glomerular disease leading to end stage renal disease,and podocyte injury is the main cause of it.The pathogenesis of podocyte injury in idiopathic FSGS is still unknown.Idiopathic FSGS is easy to relapse and the overall prognosis is poor,except for glucocorticoids and calcinurin inhibitors,there are still lack of effective treatments.Several literatures have reported that rituximab(RTX)can obtain beneficial effects in idiopathic FSGS.As a B cell depletion agent,how RTX plays a role in treatment of idiopathic FSGS,its immunological efficacy and cytoprotective mechanism are still being study.Therefore,based on the drug characteristics of RTX,this paper reviews the main clinical studies and related researches in the field of podocyte injury in recent years,presenting the immunological mechanism and podocyte protective mechanism of RTX in the treatment of idiopathic FSGS.

关 键 词：利妥昔单抗 局灶节段性肾小球硬化 B细胞 足细胞 酸性鞘磷脂酶样磷酸二酯酶3b 

分 类 号：R692.6[医药卫生—泌尿科学]