利妥昔单抗治疗狼疮肠系膜血管炎并改善肠道损伤的回顾性研究  

A retrospective study of rituximab for treatment of lupus mesenteric vasculitis and improvement of intestinal damage

作　　者：王蓓 程功 李浩[1] 王乃迪 赵亚云 冯瑞玲[1] 金月波 何菁[1] WANG Bei;CHENG Gong;LI Hao;WANG Nai-di;ZHAO Ya-yun;FENG Rui-ling;JIN Yue-bo;HE Jing(Department of Rheumatology and Immunology,Peking University People’s Hospital,Beijing 100044,China;Department of Rheumatology and Immunology,Qiandongnan People’s Hospital,Guizhou Province,Kaili 556000,China;Department of Rheumatology,Hebei Hospital of Traditional Chinese Medicine,Shijiazhuang 050000,China)

机构地区：[1]北京大学人民医院风湿免疫科,北京100044 [2]贵州省黔东南州人民医院风湿免疫科,凯里556000 [3]河北省中医院风湿病科,石家庄050000

出　　处：《中国新药杂志》2023年第22期2257-2263,共7页Chinese Journal of New Drugs

基　　金：国家重点研发计划“政府间国际科技创新合作”(2022YFE0131700);国家自然科学基金面上项目(82071813);北京大学人民医院研究与发展基金(RDZH2022-03);河北省中医药管理局科研计划项目(2021039)。

摘　　要：目的:通过比较利妥昔单抗治疗狼疮肠系膜血管炎(LMV)患者前后的临床表现、免疫指标、影像学以及人脂多糖结合蛋白(LBP)的变化,分析该治疗的临床有效性以及对肠道损伤的缓解作用。方法:回顾性分析2011年1月至2023年5月在北京大学人民医院风湿免疫科诊断为系统性红斑狼疮(SLE)继发LMV并使用利妥昔单抗治疗的患者共10例,分析其临床特点、实验室检查结果、疗效及预后,并且测定治疗前后的肠道损伤标志物LBP水平。结果:10例LMV患者经利妥昔单抗治疗后,临床症状明显改善,腹痛减轻或消失(P=0.003),胃肠壁增厚水肿减轻或消失(P=0.000),肠梗阻/肠穿孔解除(P=0.025),IgG降低(P=0.032),补体C3回升(P=0.047),B淋巴细胞百分比下降(P=0.022),SLEDAI评分下降(P=0.005),LMV缓解率100%,复发率10%。利妥昔单抗治疗后LBP浓度显著下降[(8.94±6.37)μg·mL^(-1)vs(2.89±3.21)μg·mL^(-1),P=0.04]。结论:利妥昔单抗联合糖皮质激素治疗可有效改善狼疮肠系膜血管炎患者血清免疫学指标、影像学及肠道损伤,具有良好的临床疗效,LBP有望成为狼疮肠系膜血管炎肠道损伤的评估及监测指标。Objective:To analyze the clinical efficacy of rituximab by comparing the changes of clinical manifestations,immunological features,imaging tests and human lipopolysaccharids-binding protein(LBP)before and after rituximab treatment in patients with lupus mesenteric vasculitis(LMV).Methods:A total of 10 patients diagnosed with secondary LMV of systemic lupus erythematosus(SLE)in the Department of Rheumatology and Immunology of Peking University People’s Hospital from January 2011 to May 2023 who were treated with rituximab were enrolled.Their clinical characteristics,laboratory results,efficacy and prognosis data were analyzed,and the level of intestinal injury marker LBP before and after treatment was analyzed.Results:The clinical symptoms of 10 LMV patients were significantly improved after rituximab treatment,abdominal pain lessened or disappeared(P=0.003),gastrointestinal wall thickening and edema alleviated or disappeared(P=0.000),intestinal obstruction/perforation relieved(P=0.025),IgG declined(P=0.032),complement 3 rebounded(P=0.047),the percentage of B lymphocytes decreased(P=0.022),and SLEDAI scores decreased(P=0.005).LMV remission rate was 100%,while the recurrence rate was 10%.LBP concentration decreased significantly after rituximab treatment[(8.94±6.37)μg·mL^(-1) vs(2.89±3.21)μg·mL^(-1),P=0.04].Conclusion:Rituximab combined with glucocorticoid therapy can effectively improve serum immunological features,imaging tests and intestinal damage in patients with lupus mesenteric vasculitis,and has good clinical effect.Human lipopolysaccharide-binding protein is expected to be an index for evaluating and monitoring intestinal injury in lupus mesenteric vasculitis.

关 键 词：利妥昔单抗 狼疮肠系膜血管炎 肠道损伤 人脂多糖结合蛋白 

分 类 号：R969.4[医药卫生—药理学] R977[医药卫生—药学]