利妥昔单抗治疗初始与难治复发性特发性膜性肾病的临床效果对比  

Clinical Effect of Rituximab in the Treatment of Initial and Refractory Recurrent Idiopathic Membranous Nephropathy

作　　者：李璐 冯锦红 邱晓楠 张颖 Li Lu;Feng Jinhong;Qiu Xiaonan;Zhang Ying(Department of Nephrology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院肾内科,江苏徐州221000

出　　处：《中外医药研究》2023年第19期45-47,共3页JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH

摘　　要：目的:比较利妥昔单抗(RTX)治疗初始及难治复发性特发性膜性肾病(IMN)的临床效果。方法:回顾性收集2016年6月—2022年1月徐州医科大学附属医院肾内科收治的28例IMN患者的临床资料,将其分为初始组(n=16)和复发组(n=12),均采用RTX治疗。比较28例患者治疗前后24 h尿蛋白定量、白蛋白(ALB)、血清抗磷脂酶A2受体抗体(aPLA2R-Ab)滴度、血尿素氮(BUN)、血清肌酐(Scr)、估计肾小球滤过率(eGFR)、总胆固醇(TC)、CD19+B淋巴细胞计数,临床疗效,不良反应。结果:治疗后3、6、9个月,28例IMN患者ALB高于治疗前,24h尿蛋白定量、TC、aPLA2R-Ab滴度、CD19+B淋巴细胞计数低于治疗前,差异有统计学意义(P<0.05);治疗前后BUN、Scr、eGFR比较,差异无统计学意义(P>0.05);治疗后3、6、9个月,初治组与复发组24h尿蛋白定量、ALB、aPLA2R-Ab滴度、CD19+B淋巴细胞计数比较,差异均无统计学意义(P>0.05);治疗后3、6、9个月,两组ALB水平高于治疗前,24h尿蛋白定量、aPLA2R-Ab滴度、CD19+B淋巴细胞计数低于治疗前,差异有统计学意义(P<0.05);两组治疗总有效率比较,差异无统计学意义(P>0.05);两组均无明显不良反应发生。结论:RTX对于初始治疗及既往应用激素和(或)免疫抑制剂治疗后无效或缓解后复发IMN患者临床疗效均较好,可以显著升高ALB,降低aPLA2R-Ab滴度等指标,总体有效性及安全性较好。Objective:To compare the clinical effect of rituximab(RTX)in the treatment of initial and refractory recurrent idiopathic membranous nephropathy(IMN).Methods:Clinical data of twenty-eight patients with IMN admitted to the Department of Nephrol-ogy of the Affiliated Hospital of Xuzhou Medical University from June 2016 to January 2022 were retrospectively collected,and they were divided into initial group(n=16)and refractory recurrence group(n=12),all of which were treated with RTX.The 24-hour urine protein quantification,albumin(ALB),serum anti phospholipase A2 receptor antibody(aPLA2R Ab)titer,blood urea nitrogen(BUN),serum creatinine(Scr),estimated glomerular filtration rate(eGFR),total cholesterol(TC),CD19+B lymphocyte count,clinical efficacy,and adverse reactions of twenty-eight patients before and after treatment were compared.Results:At 3,6 and 9 months af-ter treatment,ALB of 28 IMN patients was higher than before treatment,24 h urinary protein quantity,TC,aPLA2R-Ab titer and CD19+B lymphocyte count were lower than before treatment,the difference was statistically significant(P<0.05);There was no sig-nificant difference in BUN,Scr and eGFR before and after treatment(P>0.05);At 3,6 and 9 months after treatment,there was no sig-nificant difference in 24 h urinary protein quantity,ALB,aPLA2R-Ab titer and CD19+B lymphocyte count between the initial treat-ment group and the refractory recurrence group(P>0.05);At 3,6 and 9 months after treatment,ALB level was higher than before treatment,24 h urinary protein quantity,aPLA2R-Ab titer and CD19+B lymphocyte count were lower than before treatment,the dif-ference was statistically significant(P<0.05);There was no significant difference in the total effective rate between the two groups(P>0.05);No obvious adverse reactions occurred in both groups.Conclusion:RTX has good clinical efficacy for IMN patients who are ineffective after initial treatment and previous treatment with hormones and(or)immunosuppressants or relapse after remission.It can significantly increase ALB

关 键 词：利妥昔单抗 特发性膜性肾病 抗磷脂酶A2受体抗体 

分 类 号：R69[医药卫生—泌尿科学]