低剂量与标准剂量利妥昔单抗治疗原发性膜性肾病临床疗效分析  

Efficacy of low-dose and standard-dose Rituximab in patients with primary membranous nephropathy

作　　者：刘爱春[1] 梁耀先 赵新菊[1] 武蓓[1] 王伊娜[1] 燕宇[1] 董葆[1] 蔡美顺[1] 左力[1] LIU Aichun;LIANG Yao-xian;ZHAO Xin-ju;WU Bei;WANG Yi-na;YAN Yu;DONG Bao;CAI Mei-shun;ZUO Li(Department of Nephrology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院肾内科,北京100044

出　　处：《中国实用内科杂志》2024年第1期59-63,共5页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨低剂量与标准剂量利妥昔单抗(RTX)治疗原发性膜性肾病(PMN)的有效性和安全性。方法回顾性收集2020年1月至2022年6月于北京大学人民医院肾内科就诊且使用了RTX的PMN患者43例,根据RTX用量将患者分为低剂量组(20例)和标准剂量组(23例),比较两组患者基线及随访过程中临床指标和缓解率的差异,并通过多因素logistic回归探讨RTX剂量选择的影响因素及PMN治疗无反应的危险因素。结果与标准剂量组相比,低剂量组基线血红蛋白[(116.2±12.7)g/L比(132.6±16.2)g/L,P=0.014]更低,肌酐[124.0(113.0,142.0)μmol/L比77.5(69.0,94.8)μmol/L,P=0.001]更高,差异有统计学意义。总体缓解率为67.4%(29/43),标准剂量组与低剂量组缓解率无差异(69.6%比65.0%,P=0.750)。多因素logistic分析发现,肌酐(OR 0.822,95%CI 0.684~0.987,P=0.036)和血红蛋白(OR 1.821,95%CI 1.028~3.225,P=0.040)是选择低剂量RTX的独立影响因素。尿蛋白≥8 g/24 h(OR 5.854,95%CI 1.247~27.482,P=0.025)是RTX治疗PMN无反应的独立危险因素。结论短期内低剂量RTX的疗效不差于标准剂量RTX。对于血红蛋白偏低、肾功能偏差的患者,医师倾向于选择低剂量RTX治疗PMN。Objective To explore the efficacy of low‐dose and standard-dose Rituximab(RTX)for primary membranous nephropathy(PMN).Methods Patients with biopsy-proven PMN who received low-dose RTX and standard-dose RTX from January 2020 to June 2022 with follow-up in Peking University People’s Hospital,were respectively enrolled.Clinical data and laboratory indices of these patients were collected.The patients were divided into low dose group and standard dose group according to the dosage of RTX.The differences in clinical indicators and remission rate between the two groups during baseline and follow-up were compared.The factors influencing dose selection of RTX and the risk factors of nonresponse to PMN treatment were discussed through multifactor analysis.Results Patients who received low dose RTX had a lower level of hemoglobin[(116.2±12.7)g/L vs.(132.6±16.2)g/L,P=0.014],and a higher level of creatinine[124.0(113.0,142.0)μmol/L vs.77.5(69.0,94.8)μmol/L,P=0.001]than patients received standard dose RTX.The overall effective rate is 67.4%,and there was no significant difference in the remission rate between the two groups(69.6%vs.65.0%,P=0.750).Multivariate logistic regression analysis showed that higher creatinine(OR 0.822,95%CI 0.684-0.987,P=0.036),lower hemoglobin(OR 1.821,95%CI 1.028-3.225,P=0.040)were the independent risk factors for low dose RTX selection,and proteinuria≥8 g/24 h(OR 5.854,95%CI 1.247-27.482,P=0.025)was the independent risk factors of treatment no-remission.Conclusion The efficacy of low dose RTX is not inferior to that of standard dose RTX in the short term.For patients with anemia and renal dysfunction,doctors tend to choose low dose RTX to treat PMN.

关 键 词：原发性膜性肾病 利妥昔单抗 低剂量 标准剂量 有效性 

分 类 号：R692[医药卫生—泌尿科学]