单次小剂量利妥昔单抗治疗特发性膜性肾病的临床疗效分析  

Clinical efficacy of single low-dose rituximab for idiopathic membranous nephropathy

作　　者：郝思雨 丁秀[1,2,3,4] 刘会彬 吴成态[1,2,3,4] 王小琴 邹新蓉 Hao Si-yu;Ding Xiu;Liu Hui-bin;Wu Cheng-tai;Wang Xiao-qin;Zou Xin-rong(First Clinical College of Hubei University of Traditional Chinese Medicine,Wuhan 430061,China;Hubei Hospital of Traditional Chinese Medicine,Wuhan 430061,China;Hubei Academy of Traditional Chinese Medicine,Wuhan 430074,China;Hubei Key Laboratory of Hepatorenal Researches and Application of Traditional Chinese Medicine,Wuhan 430061,China)

机构地区：[1]湖北中医药大学,武汉430061 [2]湖北省中医院,武汉430061 [3]湖北省中医药研究院,武汉430074 [4]中医肝肾研究及应用湖北省重点实验室,武汉430061

出　　处：《临床肾脏病杂志》2023年第9期712-720,共9页Journal Of Clinical Nephrology

基　　金：第五批全国中医临床优秀人才研修项目[国中医药人教函[2022]1号]。

摘　　要：目的探讨单次小剂量利妥昔单抗(rituximab,RTX)治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)的有效性与安全性及与常规剂量治疗的差异。方法回顾性分析2019年12月至2022年11月湖北省中医院光谷院区肾病科通过肾穿刺病理和检测抗磷脂酶A2受体抗体阳性诊断为IMN且使用RTX治疗的患者25例,在基础支持治疗方案基础上,单次小剂量组15例,使用RTX 200 mg/次;常规剂量组10例,使用RTX 500 mg/次,两组均为1次/周,总剂量2000 mg,对比两组治疗前与治疗3个月、治疗6个月的相关实验室检测指标。结果治疗3个月,单次小剂量组总缓解率33%,常规剂量组总缓解率60%,两组总缓解率差异无统计学意义(P>0.05);治疗6个月,单次小剂量组总缓解率40%,常规剂量组总缓解率70%,两组总缓解率差异无统计学意义(P>0.05)。单次小剂量组治疗3个月、治疗6个月24 h尿蛋白定量分别为(3.42±2.59)g、(1.96±3.25)g,血白蛋白水平分别为(26.40±9.90)g/L、(40.35±5.06)g/L,血红蛋白含量分别为(120.00±13.30)g/L、(130.60±19.10)g/L,CD19^(+)B淋巴细胞水平分别为(6.33±5.50)个/μL、(2.67±9.25)个/μL,CD19^(+)B淋巴细胞计数<5个/μL分别为7例、13例,抗磷脂酶A2受体抗体阴性率分别为12例、14例,红细胞沉降率分别为(48.93±25.89)mm/h、(38.13±31.03)mm/h,总胆固醇分别为(5.27±1.59)mmol/L、(4.67±1.49)mmol/L,低密度脂蛋白分别为(2.80±1.22)mmol/L、(2.58±0.63)mmol/L,D-2聚体分别为(0.36±0.29)mg/L、(0.11±0.15)mg/L,与治疗前相比,组内差异均有统计学意义(P<0.05)。常规剂量组治疗3个月、治疗6个月24 h尿蛋白定量分别为(3.20±3.56)g、(1.06±1.14)g,血白蛋白水平分别为(32.10±8.00)g/L、(36.26±4.34)g/L,血红蛋白含量分别为(129.60±15.70)g/L、(134.70±10.99)g/L,CD19^(+)B淋巴细胞水平分别为(5.50±4.74)个/μL、(2.30±6.25)个/μL,CD19^(+)B淋巴细胞计数<5个/μL分别为9例、9例,抗磷脂酶A2受体抗体阴性率分别为7�Objective To explore the efficacy and safety of single small-dose rituximab for idio-pathic membranous nephropathy(IMN)and examine the difference with conventional-dose therapy.Methods From December 2019 to November 2022,retrospective analysis was conducted for 25 IMN patients at Department of Nephrology,Guanggu Hospital,Hubei Provincial Hospital of Traditional Chinese Medicine.A definite diagnosis of IMN was made by renal puncture pathology and detection of positive anti-phospholipase A2 receptor antibody and using rituximab(RTX).An overall dose of 2,000 mg RTX was offered on the basis of basic supportive treatment.The once weekly dose was 200 mg in single small-dose group(n=15)versus 500 mg in conventional-dose group(n=10).The relevant laboratory parameters of two groups were compared at pretreatment with those at Month 3/6 post-treatment.Results At Month 3,overall remission rate was 33%in single small-dose group versus 60%in conventional-dose group and the inter-group difference was not statistically significant(P>0.05);at Month 6,overall remission rate was 40%in single small-dose group versus 70%in conventional-dose group and the inter-group difference was not statistically significant(P>0.05).At Months 3 and 6,quantitative 24 h urine protein was[(3.42±2.59)g vs(1.96±3.25)g],blood albumin[(26.40±9.90)g/L vs(40.35±5.06)g/L],hemoglobin[(120.00±13.30)g/L vs(130.60±19.10)g/L],CD19^(+)B lymphocyte[(6.33±5.50)cells/μL vs(2.67±9.25)cells/μL],proportion of CD19^(+)B lymphocyte count<5/μL(n=7 vs n=13),nega-tivity rate of anti-phospholipase A2 receptor antibody(n=12 vs n=14),erythrocyte sedimentation rate[(48.93±25.89)mm/h vs(38.13±31.03)mm/h],total cholesterol[(5.27±1.59)mmol/L vs(4.67±1.49)mmol/L],low-density lipoprotein[(2.80±1.59)mmol/Lvs(4.67±1.49)mmol/L]and D-2 dimer[(0.36±0.29)mg/L vs(0.11±0.15)mg/L]were statistically different from those pre-treatment(P<0.05).In conventional-dose group,24 h urine protein quantification was[(3.20±3.5)g vs(1.06±1.14)g],blood albumin[(32.10±8.00)g/L vs(36.26�

关 键 词：利妥昔单抗 特发性膜性肾病 低剂量 有效性 安全性 

分 类 号：R692[医药卫生—泌尿科学]