利妥昔单抗治疗成人不典型膜性肾病的疗效分析  

Efficacy analysis of rituximab in treatment of atypical membranous nephropathy in adults

作　　者：单彬[1] 黄东阳 徐茜茜[4] 梁平[1] 霍丽曼 唐崑[5] SHAN Bin;HUANG Dong-yang;XU Qian-qian;LIANG Ping;HUO Li-man;TANG Kun(Department of Pharmacy,the Fourth Hospital of Hebei Medical University,Shijiazhuang HEBEI 05001l,China;Department of Pharmacology,School of Basic Medical Science,Hebei Medical University,Shijiazhuang HEBEI 05001l,China;Department of Pharmacology of Chinese Materia Medica,Institute of Chinese Integrative Medicine,Hebei Medical University,Shijiazhuang HEBEI 05001l,China;Department of Nephrology,China-Japan Friendship Hospital,BEIJING 100020,China;Department of Pharmacy,China-Japan Friendship Hospital,BEIJING 100020,China)

机构地区：[1]河北医科大学第四医院药学部,河北石家庄050011 [2]河北医科大学基础医学院药理教研室,河北石家庄050011 [3]河北医科大学中西医结合学院中药与中药药理教研室,河北石家庄050011 [4]中日友好医院肾内科,北京100020 [5]中日友好医院药学部,北京100020

出　　处：《中国新药与临床杂志》2022年第10期612-617,共6页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的 探讨利妥昔单抗(RTX)对成人不典型膜性肾病(AMN)的疗效。方法 选择某三甲医院应用RTX后随访12~24个月,且表现为肾病综合征的AMN患者。根据其临床资料,分析患者应用RTX后24 h尿蛋白、肌酐、肌酐清除率、白蛋白、B细胞计数的变化,以及临床缓解和不良反应发生情况。并根据RTX单次用量是否超过100 mg将患者分组,比较不同剂量RTX对患者缓解的影响。结果 共纳入12例患者,观察期内10例出现部分缓解,9例出现完全缓解。与治疗前比较,治疗3个月起白蛋白上升、治疗6个月起24 h尿蛋白下降,差异均有显著意义(P <0.05);治疗3个月起B细胞计数下降,治疗3、6个月显著低于治疗前(P <0.05);各观察时点肌酐及肌酐清除率无明显变化(P> 0.05)。大剂量组患者7例,RTX累积用量0.6~4.0 g,小剂量组5例,RTX累积用量0.3~0.6 g。小剂量组缓解出现时间、缓解持续时间均长于大剂量组,但无显著差异(P> 0.05)。随访期内无严重不良反应发生,无感染发生。结论 RTX能够改善AMN患者的24 h蛋白尿、B细胞计数及白蛋白水平,稳定肾功能,且较安全,实际临床中推荐选择小剂量RTX。AIM To explore the efficacy of rituximab( RTX) for atypical membrane kidney disease( AMN) in adults. METHODS AMN patients with nephrotic syndrome were screened, who were followed up for 12 to 24 months after application of RTX in a tertiary hospital. According to their clinical data, the changes of the 24 h urine protein, creatinine, creatinine clearance rate, albumin, B cell count, clinical remission and adverse reactions were observed after appling RTX. The patients were divided into groups according to whether the single dose of RTX exceeded 100 mg, and then compared the effects of different doses of RTX on the remission. RESULTS Twelve patients were included. During the observation period, there were 10 cases showed partial remission and 9 cases showed complete remission. Compared with before treatment, albumin increased after 3 months of treatment, and 24 h urine protein decreased after 6 months of treatment, the differences were significant(P < 0.05);the B cell count decreased after 3 months of treatment, and was significantly lower than before treatment at 3 and 6 months after treatment( P < 0.05);creatinine and creatinine clearance rate at each observation time point had no significant change(P > 0.05). The time to remission and the duration of remission in the low-dose group were longer than those in the high-dose group, but there was no significant difference( P > 0.05). No serious adverse reactions and infection occurred during the followup period. CONCLUSION In AMN patients, RTX can significantly reduce 24 h proteinuria and B cell count, raise albumin level, stabilize renal function, and is relatively safe. In practice, low-dose RTX is recommended.

关 键 词：利妥昔单抗 肾小球肾炎 膜性 肾病综合征 不典型膜性肾病 免疫相关肾病 

分 类 号：R692[医药卫生—泌尿科学] R977[医药卫生—外科学]