利妥昔单抗联合环磷酰胺、泼尼松对特发性膜性肾病患者肾功能及血清抗M型磷脂酶A2受体抗体水平的影响  

Effects of Rituximab Combined with Cyclophosphamide and Prednisone on Renal Function and Serum Level of Anti-M-Type Phospholipase A2 Receptor Antibody in Patients with Idiopathic Membranous Nephropathy

作　　者：陈忠锋 夏楠楠 魏艳林[3] 焦琳珊 王瑞 何兵 CHEN Zhong-feng;XIA Nan-nan;WEI Yan-lin;JIAO Lin-shan;WANG Rui;HE Bing(Department of Nephrology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China;Department of Rheumatology and Immunology,Zhengzhou Central Hospital A f f i l i a t e d to Zhengzhou University,Zhengzhou 450000,China;Department of Rheumatology and Immunology,People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院肾病内科,郑州450000 [2]郑州大学附属郑州中心医院风湿免疫科,郑州450000 [3]郑州人民医院风湿免疫科,郑州450000

出　　处：《中国合理用药探索》2024年第8期104-110,共7页Chinese Journal of Rational Drug Use

基　　金：河南省二〇二三年科技发展计划项目(232102310163)。

摘　　要：目的:探讨利妥昔单抗联合环磷酰胺、泼尼松对特发性膜性肾病(IMN)患者肾功能、血清抗M型磷脂酶A2受体(PLA2R)抗体水平等的影响。方法:选取2020年6月~2022年12月期间某院诊治的64例IMN患者作为研究对象,采用随机数字表法分为对照组和观察组,每组32例。所有患者均接受控制血压、调脂、抗凝等常规治疗,对照组患者在常规治疗基础上加用醋酸泼尼松片、注射用环磷酰胺,观察组患者在对照组治疗基础上加用利妥昔单抗注射液。比较两组患者血清白蛋白、血脂指标[总胆固醇(TC)和甘油三酯(TG)]、血清抗PLA2R抗体水平、肾功能指标[血清肌酐(Scr)、血尿素氮(BUN)]、24h尿蛋白定量(24hpro)及不良反应发生情况。结果:治疗后,两组患者血清白蛋白水平均升高(P<0.05),且观察组高于对照组(P<0.05);TC、TG水平均降低(P<0.05),且观察组低于对照组(P<0.05);血清抗PLA2R抗体水平均降低(P<0.05),且观察组低于对照组(P<0.05);Scr和BUN水平均降低(P<0.05),且观察组低于对照组(P<0.05);24hpro均降低(P<0.05),且观察组低于对照组(P<0.05)。两组患者不良反应发生率比较无统计学差异(P>0.05)。结论:利妥昔单抗联合环磷酰胺、泼尼松治疗可提高患者血清白蛋白水平,调节血清抗PLA2R抗体及血脂水平,改善患者肾功能,且不会增加不良反应的发生风险。Objective:To investigate the effects of rituximab combined with cyclophosphamide and prednisone on renal function and serum level of anti-M-type phospholipase A2 receptor(PLA2R)antibody in patients with idiopathic membranous nephropathy(IMN).Methods:A total of 64 IMN patients treated in a hospital from June 2020 to December 2022 were selected and assigned to the control group and observation group by random number table method,with 32 patients in each group.All patients were treated with conventional treatment such as blood pressure control,lipid regulation and anticoagulation,the control group was given prednisone acetate tablets and cyclophosphamide for injection in addition to the conventional treatment,and the observation group was treated with rituximab injection in addition to the treatment given in the control group.Serum level of albumin,blood lipid parameters[total cholesterol(TC)and triglyceride(TG)],serum level of anti-PLA2R antibody,renal function indices[serum creatinine(Scr),blood urea nitrogen(BUN)],24h urinary protein quantification(24hpro)and adverse reactions were compared between the two groups.Results:After treatment,the serum level of albumin were increased in both groups(P<0.05),and was higher in the observation group than that in the control group(P<0.05).TC and TG levels were decreased in both groups(P<0.05),and were lower in the observation group than those in the control group(P<0.05).The serum level of anti-PLA2R antibody was decreased in both groups(P<0.05),and was lower in the observation group than that in the control group(P<0.05).The levels of Scr and BUN were decreased in both groups(P<0.05),and were lower in the observation group than those in the control group(P<0.05).The 24hpro was decreased in both groups(P<0.05),and was lower in the observation group than that in the control group(P<0.05).No statistically significant difference in the incidence of adverse reactions was observed between the two groups(P>0.05).Conclusion:Rituximab combined with cyclophosphamide and prednisone c

关 键 词：利妥昔单抗 泼尼松 特发性膜性肾病 肾功能 抗M型磷脂酶A2受体抗体 

分 类 号：R692[医药卫生—泌尿科学]